“We found that women were less likely to be treated with a modifying treatment of the disease (DMT) than men with the same level of severity of the disease, even taking into account patients who stopped taking their medication during pregnancy or after childbirth,” said Professor Sandra Vukusic, head of the neurology service – multiple sclerosis, myelin and neuro -inflammation pathologies – of the Civil Hospices in Lyon, in a press release from the ‘American Academy of Neurology.
According to his work published in Neurology, Women are less likely than men to receive sclerosis drugs in plates (MS) between 18 and 40 years old, during their procreation period, while these drugs proved to be without danger during pregnancy or that they have a prolonged effect against the disease despite a pre-designual stop. “Women who are not treated could have less good long -term results and run an increased risk of disability. This loss of opportunity is no longer acceptable because there are drugs compatible with pregnancy or which can continue to fight the disease long after people have stopped taking them when they try to design ”, denounces the septologist.
“Therapeutic inertia is a persistent challenge in the field of MS which has lasting consequences. This is particularly worrying for women, who represent approximately three -quarters of the population with MP. It is therefore essential to tackle the disparities based on sex ”also note the Prs Gabriel Bsteh and Harald Hegen, Austrian neurologists, in an editorial.
In 2022, the French-speaking Society of Sclerosis in Plate (SFSEP) updated the recommendations “pregnancy in MS and the NMO spectrum diseases”, under the co-director of Professor Sandra Vukusic and Christine Lebrun-Frenay, by devoting a point on compatible treatments with pregnancy.
20 % chance in less to receive highly modifying treatments
The team of researchers looked at more than 27 years of medical records of people with a recurrent-remitting MS who started between their 18 and 40 years (French sep Observatory register, OFSEP). A total of 16,857 women and 5,800 men, an average of 29 years, were included in the study and followed for 12 years on average. After adjusting according to the severity of the disease, pregnancy and the postpartum period, the authors observe that women were 8 % less likely than men to receive a DMT. A proportion that amounts to 20 % for new drugs very effective in reducing relapses. The disparities occur from 1 to 2 years after the appearance of the disease and persist at least during the first decade of follow -up.
Among the 5,268 women who gave birth during the follow -up period, the use of DMTs began to decrease 18 months before design, going from 42.6 to 27.9 % at the estimated time of design. The authors have not benefited from information on any pregnancies ending with a miscarriage or a mortinity, as well as on unsuccessful pregnancy attempts. “The treatment stops due to these events were therefore taken into account by adjusting the results according to sex”, they explained.
Therapeutic inertia and prejudices
“The anticipation of pregnancy has probably played an important role in this difference between women and men with MS, but there could also be a reluctance to use these treatments when they are in reality the best way to take care of the disease and delay the appearance of a handicap”, commented Professor Vukusic.
Lyon neurologists also point out the possible gap between research speed and information made to doctors and their patients. “Prudence linked to pregnancy and therapeutic inertia are two closely linked, but distinct phenomena”, Add the editorialists. “The factors contributing to the underuse of DMTs probably include persistent persistent ideas on fetal risk, the prejudices of clinicians concerning the tolerance of women with powerful therapies, and systemic obstacles such as inconsistent surveillance protocols and insufficient availability of decision-making tools. »»