Oral contraceptive use and MS prognosis

Epub ahead of printSena et al. Oral contraceptive use and clinical outcomes in patients with multiple sclerosis. J Neurol Sci. 2012 Mar 27.  

Background: Experimental and clinical data suggest a role of sex steroids in the pathogenesis of MS. Scant information is available about the potential effect of oral contraceptive (OC) use on the prognosis of the disease. 

Aim: This study evaluate the impact of OC use on prognosis. 

Method: The study population consisted of 132 women with relapsing-remitting MS before receiving disease modifying treatment and a mean disease duration 6.2 (SD 5.1) years. Three groups of MSers were distinguished according to their OC behavior: [1] never-users, patients who never used OC [2] past-users, patients who stopped OC use before disease onset, and [3] after-users, those who used these drugs after disease onset. 

Results: After-user MSers had lower EDSS and Multiple Sclerosis Severity Score (MSSS) values than never users (p<0.001 and p=0.002, respectively) and past users (p=0.010 and p=0.002, respectively). These MSers were also more likely to have a benign disease course (MSSS<2.5) than never and past users together (OR: 4.52, 95%CI: 2.13-9.56, p<0.001). This effect remained significant after adjustment for confounders, including smoking and childbirths (OR: 2.97, 95%CI: 1.24, 6.54, p=0.011 and for MSSS β: -1.04; 95% C.I. -1.78, -0.30, p=0.006). 

Conclusions: These results suggest that OC use in women with relapsing-remitting MS is possible associated with a milder disabling disease course.

“This study needs to be reproduced. The odds are that it is a false positive. The best way to study this is using a prospective study design. It is very important because it suggests that the OC, a hormone therapy, may be beneficial for MS. This is not an outlandish claim; it is well established that pregnancy is beneficial for woman with MS. The OC induces a state of pseudo-pregnancy; i.e. it fools the brain into thinking it is pregnant and therefore prevents the endocrine signals that induce ovulation. So there may be something to this story.”

“Even if the benefits of the OC are small they could potentially add-up and make a difference overall.”

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