COPP-MS: COrticosteroids during the Post-Partum in relapsing Multiple Sclerosis patients

Area of Science:

• Neurology
• Immunology
• Reproductive Medicine

Background:

• Postpartum relapses are a significant concern for women with multiple sclerosis (MS).
• Current treatments lack proven effectiveness in preventing these postpartum MS relapses.

Purpose of the Study:

• To evaluate the efficacy of prophylactic high-dose corticosteroids in preventing postpartum relapses in MS.
• To compare outcomes between women receiving standardized preventive treatment and those receiving no preventive treatment.

Main Methods:

• A comparative study involving five French MS centers with distinct postpartum management strategies (high-dose steroids vs. no treatment).
• Inclusion of relapsing-remitting MS women who delivered between 2007 and 2017.
• Analysis of time to first relapse, Expanded Disability Status Scale (EDSS) progression, and MRI activity, adjusted for propensity scores.

Main Results:

• 350 patients were analyzed; relapse rates decreased during pregnancy but increased postpartum in both groups.
• Annualized relapse rates in the first postpartum trimester were 0.45 (steroids) and 0.69 (no treatment).
• No statistically significant differences were observed in primary outcomes (time to relapse, EDSS progression, MRI activity) between the treatment and no-treatment groups.

Conclusions:

• Systematic high-dose corticosteroid administration does not appear to reduce postpartum inflammatory activity in multiple sclerosis patients.
• The study provides Class III evidence against the routine use of preventive corticosteroids for postpartum MS management.