title: Oral contraceptive use and clinical outcomes in patients with multiple sclerosis.
abstract: Experimental and clinical data suggest a role of sex steroids in the pathogenesis of multiple sclerosis (MS). Scant information is available about the potential effect of oral contraceptive (OC) use on the prognosis of the disease. We aimed to evaluate this. 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 patients 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. Multiple linear and logistic regression models were used to analyze the association between oral contraceptive use and annualized relapse rates, disability accumulation and severity of the disease. After-user patients had lower Expanded Disability Status Scale (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 patients 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). These results suggest that OC use in women with relapsing-remitting MS is possible associated with a milder disabling disease course.
authors.affiliation: CEDOC Faculty of Medical Sciences, Universidade Nova de Lisboa and Neurology Department, Santo Antonio dos Capuchos Hospital, Lisbon, Portugal. armando.sena@fcm.unl.pt
authors.forename: Armando
authors.initials: A
authors.lastname: Sena
authors.forename: Rémy
authors.initials: R
authors.lastname: Couderc
authors.forename: Joana C
authors.initials: JC
authors.lastname: Vasconcelos
authors.forename: Véronique
authors.initials: V
authors.lastname: Ferret-Sena
authors.forename: Rui
authors.initials: R
authors.lastname: Pedrosa
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003276:Contraceptives, Oral / Q000008:administration & dosage*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D009103:Multiple Sclerosis / Q000188:drug therapy* / Q000453:epidemiology*; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D003276:Contraceptives, Oral