title: Long-term influence of combined oral contraceptive use on the clinical course of relapsing-remitting multiple sclerosis.
abstract: OBJECTIVE
  To assess the long-term effects of combined oral contraceptives (COCs) on the clinical course of relapsing-remitting multiple sclerosis (RRMS), focusing on disability progression and evolution to secondary-progressive multiple sclerosis (SPMS).
  
  
  METHODS
  Retrospective and exploratory study.
  
  
  METHODS
  Academic medical center.
  
  
  METHODS
  A total of 174 women with clinically confirmed MS; of these, 33 had evolved to SPMS at the time of enrollment in the study, whereas 141 still had a relapsing-remitting form of disease.
  
  
  METHODS
  Women were interviewed to obtain gynecologic and obstetric history.
  
  
  METHODS
  Expanded Disability Status Scale (EDSS); Multiple Sclerosis Severity Score (MSSS); annualized relapse rate; evolution to SPMS.
  
  
  RESULTS
  Mean±SD duration of disease was 14.3±9.8 years. Compared with non-users of COCs, COC users had lower EDSS scores and MSSS only in the subset of the population with prior or current immunomodulatory treatment. Nonuse of COCs was a predictor of disease evolution in SPMS, whether treated or not with immunomodulatory drugs. The annualized relapse rate was not influenced by COC use. No differences in EDSS scores and evolution to SPMS depending on COC formulation were detected.
  
  
  CONCLUSIONS
  Our results suggest that COC use is associated with a less severe disease and less severe evolution. Whether different doses or types of progestin may have different effects remains to be defined.
authors.affiliation: Gynecology and Physiopathology of Human Reproduction, University of Bologna and S. Orsola-Malpighi Hospital, Bologna, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Gava
authors.affiliation: Center for Rare and Neuroimmunological Diseases, Scientific Institute for Research, Hospitalization and Health Care (IRCCS), Istituto delle Scienze Neurologiche di Bologna, Bellaria Hospital, Bologna, Italy.
authors.forename: Ilaria
authors.initials: I
authors.lastname: Bartolomei
authors.affiliation: Gynecology and Physiopathology of Human Reproduction, University of Bologna and S. Orsola-Malpighi Hospital, Bologna, Italy.
authors.forename: Antonietta
authors.initials: A
authors.lastname: Costantino
authors.affiliation: Gynecology and Physiopathology of Human Reproduction, University of Bologna and S. Orsola-Malpighi Hospital, Bologna, Italy.
authors.forename: Marta
authors.initials: M
authors.lastname: Berra
authors.affiliation: Gynecology and Physiopathology of Human Reproduction, University of Bologna and S. Orsola-Malpighi Hospital, Bologna, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Venturoli
authors.affiliation: Center for Rare and Neuroimmunological Diseases, Scientific Institute for Research, Hospitalization and Health Care (IRCCS), Istituto delle Scienze Neurologiche di Bologna, Bellaria Hospital, Bologna, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Salvi
authors.affiliation: Gynecology and Physiopathology of Human Reproduction, University of Bologna and S. Orsola-Malpighi Hospital, Bologna, Italy. Electronic address: cristina.meriggiola@unibo.it.
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: Meriggiola
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D003277:Contraceptives, Oral, Combined / Q000008:administration & dosage*; D003278:Contraceptives, Oral, Hormonal / Q000008:administration & dosage*; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D018450:Disease Progression; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D020528:Multiple Sclerosis, Chronic Progressive / Q000175:diagnosis / Q000453:epidemiology*; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000175:diagnosis / Q000453:epidemiology*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors
chemical_list: D003277:Contraceptives, Oral, Combined; D003278:Contraceptives, Oral, Hormonal
keywords: Disability; multiple sclerosis; neurologic outcome; oral contraceptives; sex steroids