12 Dec 2018

Monash study to better inform pregnant women with MS

Dr Vilija Jokubaitis is working on
multiple sclerosis in pregnancy
Series about National Health and Medical Research Council (NHMRC) Project Grant recipients in Central Clinical School (CCS) starting in 2019

by Anne Crawford

Planning a family can be a hard decision at the best of times; add to that having Multiple Sclerosis (MS) and it can be fraught. A Monash University researcher in the Department of Neuroscience at Central Clinical School is investigating the impact of pregnancy on disease outcomes in women with MS to generate information that will both deepen understanding of the disease and which can be used by clinicians to assist patients.

Dr Vilija Jokubaitis will be able to further her current research into MS, prognosis and pregnancy thanks to a $470,000 grant from the NHMRC.

“Women are disproportionately affected by MS, and typically diagnosed in their key reproductive years,” she said. “The grant we’ve received funds a project that really aims at trying to dissect out what impact pregnancy has on the long-term outcome for women with MS.”

Studies in the past have suggested that pregnancy may have beneficial or protective effects for women with MS, a finding Dr Jokubaitis will interrogate. “It could be an issue of reverse causality,” she said, “MS has a huge spectrum of outcomes from very mild to very severe cases. The beneficial effects reported could just be because the women with mild disease are the ones choosing to become pregnant so they were slated to have better disease outcomes all along.”

Dr Jokubaitis, who heads the Neuroimmunology Genomics and Prognostics Group in Department of Neuroscience, will oversee research that looks retrospectively at observational data about patients and ‘matches’ women with or without pregnancies based on factors such as age and disease characteristics, then compares outcomes for matched women. “It’s the closest equivalent to a randomised controlled trial that we have using observational data.”

She said preliminary evidence from her group using this method suggested that pregnancy does seem to have a protective effect.

Collaborating with the international clinical register, MSBase, Dr Jokubaitis will expand this early research, analysing information from more than 5000 women with MS.

“At the moment there’s a lot of uncertainty around pregnancy for women diagnosed with MS. Some are concerned they might pass on MS to their children, others are concerned they may not be physically able to look after their children and some women are concerned about becoming pregnant when they’re on disease-modifying medication.”

The researchers will also monitor the outcomes of children born to women with MS in terms of whether the mothers involved were taking such medication at the time of pregnancy.

“I’m hoping we can give women reassurance and better advice so they can make informed decisions about family planning, and better guidelines because at the moment there’s no really good evidence-based recommendations,” Dr Jokubaitis said.

“This study will ultimately impact on the way clinicians counsel their patients and hopefully change clinical practice.”

Dr Jokubaitis has already seen clinical practice change as a result of her research. A paper published in Neurology in 2014 investigating two MS medications recommended that the ‘washout’ period – the time needed for medication to be eliminated from the body before moving onto to another – be shortened. “After the paper was published we saw a global shift in the washout period,” she said.

Dr Jokubaitis is also proud of the platform paper she delivered in 2013 European Committee for Treatment and Research in MS before an audience of 6000, which was well-received, and the Fellowship from MS Research Australia for work in MS genetics.

She joined the Department of Neuroscience in late January when she was asked to head the new Neuroimmunology Genomics and Prognostics Group.

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