Disease-Modifying Drug Treatment before, during, and after Pregnancy in Women with Multiple Sclerosis and a Live Birth

Background: US data on disease-modifying drug (DMD) treatment before, during, and after pregnancy are limited.

Objectives: To evaluate DMD treatment before, during, and after pregnancy in women with multiple sclerosis (MS) and a live birth using US administrative claims data.

Methods: A retrospective analysis of women with MS (ICD-9-CM code 340.xx), aged 18–65 years, a claim indicative of a live birth, and 1-year continuous eligibility pre/post-pregnancy in the IMS Health Real World Data Adjudicated Claims US database from January 1, 2006 to June 30, 2015 was conducted. DMD treatment was evaluated during the year prior to pregnancy (3-month intervals), the three trimesters of pregnancy, puerperium (6 weeks post-pregnancy), and 1-year post-pregnancy (7–12 weeks post-pregnancy and 3–6, 6–9, and 9–12 months post-pregnancy). The proportion of women exposed to DMD treatment during the 12 time periods was evaluated. Results were also stratified by the number of relapses women experienced in the year prior to pregnancy.

Results: Of 190,475 women with MS, 2,158 met eligibility criteria. Mean (standard deviation [SD]) age was 30.26 (4.68) years. Most had commercial health insurance (98.56%), and were from the Midwest (32.19%), South (30.57%), or Northeast (29.05%) regions. The proportion with MS and a live birth treated with any DMD was 20.48% 9–12 months pre-pregnancy, 21.46% 6–9 months pre-pregnancy, 20.62% 3–6 months pre-pregnancy, and 17.75% 3 months pre-pregnancy. During pregnancy, the proportion of women treated with a DMD decreased to 12.05% during the first trimester, 1.90% during the second trimester, and then increased slightly to 2.97% during the third trimester. The proportion of women treated with DMDs increased to 8.34% during puerperium, 12.93% during 7–12 weeks post-partum, 21.97% from 3–6 months post-partum, 24.47% from 6–9 months post-partum, and 25.49% from 9–12 months post-partum. The majority of women (81.9%) received DMD treatment by 6–9 months post-partum. The proportion of women with DMD treatment before and after pregnancy increased numerically with the number of relapses experienced pre-pregnancy.

Conclusions: In this population of women with MS and a live birth, the rate of DMD treatment decreased pre-pregnancy and during pregnancy, and increased steadily post-partum.