Gender Disparities in Multiple Sclerosis Treatment During Pregnancy
A recent study from France reveals that women with multiple sclerosis (MS) in their reproductive years are significantly less likely than their male counterparts to receive disease-modifying therapies (DMTs), despite evidence suggesting these treatments are safe during pregnancy.
The research identified what they describe as a “sex-related gap” in the application of DMTs among women and men diagnosed with relapsing-remitting MS (RRMS) between the ages of 18 and 40. The study’s authors are advocating for improved education for both doctors and patients regarding the latest recommendations on DMTs, particularly in relation to pregnancy, to help address this disparity.
Dr. Sandra Vukusic from the University of Lyon emphasized that “when used early, MS drugs can delay the burden of the disease.” She expressed concern that untreated women might face worse long-term outcomes and a heightened risk of disability. “This loss of opportunity is no longer acceptable, as there are medications compatible with pregnancy,” she added.
The research, titled “Sex-Related Gap in the Use of Disease-Modifying Therapies in Multiple Sclerosis,” was published in the journal Neurology.
MS occurs when the immune system mistakenly attacks the myelin sheath protecting nerve fibers, impacting electrical signal transmission. It is more commonly diagnosed in women and young adults, with female gender being a significant risk factor for developing the disease. Treatment options have significantly improved lately, especially with the introduction of various DMTs that have been shown to provide better long-term outcomes if started early in the disease progression.
Study Observations
The study team analyzed health records of 16,857 women and 5,800 men, all diagnosed with RRMS between the ages of 18 to 40, following them for a median of 11.6 years. The results displayed that women were less likely to receive DMTs than men, with only 60.2% of women being treated compared to 61.3% of men. When it came to highly effective DMTs, the figures were 23.5% for women versus 25.3% for men.
After adjusting for factors like more active disease in women and treatment halts during pregnancy or postpartum, the researchers found an 8% lower likelihood for women to receive any DMT. Furthermore, the disparity rose to 20% for highly effective treatments.
Dr. Vukusic noted that this gap in treatment became apparent just two years after disease onset for general DMTs and one year for more effective options, remaining consistent regardless of the patients’ age.
Underutilization of Specific Treatments
The study also highlighted certain treatments that were significantly underused among women, such as teriflunomide (Aubagio) and sphingosine-1-phosphate receptor (S1PR) modulators like fingolimod (Gilenya). Other underutilized therapies included CD20 inhibitors such as ocrelizumab (Ocrevus).
Although interferon-based medications and natalizumab (Tysabri) were initially less administered to women, their usage eventually balanced out between genders over time. Interestingly, treatments like glatiramer acetate (Copaxone) and dimethyl fumarate (Tecfidera) began with equal use but saw an increase among women later on.
Anticipation of pregnancy likely played a significant role in the disparity between treatment access for women and men, but there may also be hesitance to use therapies that could effectively manage the disease and delay its progression.
The findings indicated a noticeable decline in DMT use among women who were expecting, dropping from 42.6% to 27.9% leading up to conception. Dr. Vukusic acknowledged that various factors, including potential delays in understanding the safety of newer treatments, could explain this trend.
Overall, the study’s results highlight a crucial need for raising awareness among healthcare professionals and patients about recommended DMT usage, especially for women of childbearing age, which could help mitigate harmful therapeutic inertia.
