Gynecologic complications of disease-modifying therapy in women with multiple sclerosis

Background/Objectives: The long-term implications of multiple sclerosis (MS) disease-modifying therapies (DMTs) on gynecologic health remain understudied. We leverage a multicenter database to evaluate whether DMTs are associated with such complications. Methods: We propensity-score 1:1 matched women with MS on (1) any versus no or (2) moderate- to high- (vs low-) immunosuppressive DMT by age, marital status, race, ethnicity, tobacco use, body mass index, human papilloma virus (HPV) vaccination, and gynecologic examinations/screenings. We then compared matched cohorts with risk ratios (RRs) and 95% confidence intervals (CIs). Results: After matching, we analyzed 115,522 women with MS. The DMT (vs no DMT) group had increased risks of HPV positivity (RR: 1.52, 95% CI: 1.35–172), cervical dysplasia (RR: 1.40, 95% CI: 1.31–1.49), cervical cancer (RR: 1.23, 95% CI: 1.03–1.46), cervicitis (RR: 1.25, 95% CI: 1.10–1.41), herpes simplex virus positivity (RR: 1.29, 95% CI: 1.14–1.45), vulvovaginitis (RR: 1.30, 95% CI: 1.23–1.37), and Bartholin cysts/abscesses (RR: 1.37, 95% CI: 1.07–1.76). Moderate- to high- (vs low-) immunosuppressive. Discussion: MS DMTs, especially more immunosuppressive ones, are associated with increased risks of several gynecologic complications. Clinicians should recognize these potential sequelae of DMTs and integrate gynecological counseling/screening into MS care.