020 Increased risk of an abnormal cervical screening test in women with MS exposed to high-efficacy disease-modifying treatments

Abstract

Introduction: Long-term exposure of women with Multiple sclerosis (MS, wwMS) to immunomodulatory treatments may increase the risk of cervical dysplasia. However, little is known about cervical dysplasia risk and Human Papillomavirus (HPV)- vaccine coverage in wwMS. Method(s): Adult wwMS were recruited from two tertiary MS clinics in Melbourne. To explore the association of MS treatments (DMTs) on abnormal cervical screening tests (CSTs), we linked individual data from MSBase, the state-wide Victorian Cervical Screening Registry, and National HPV vaccination registry (NHPVVR) of Australia. Result(s): To date we have recruited 208 wwMS, of whom 102 (average age 33.8 yrs) had complete data (vaccination status, cervical screening status and MSBase data) and had no prior history of cervical dysplasia at MS onset (analysis eligible) for this interim analysis. Most women (58, 88%) were unvaccinated. 19 wwMS (19%) had an abnormal CST after MS onset (incidence rate 20.6 cases/1000 person-years, 95% confidence interval 12.4-32.1) over average 9.0 years of follow-up. DMT exposures included 57 on lower-efficacy (BRACE) therapies (56%), 73 on a high-efficacy therapy (72%), and 44 used both. Eight abnormal CSTs were detected before starting high-efficacy therapy (rate 12.6, 95% CI (5.4-24.8)) and 11 were detected after starting high-efficacy therapy (rate 38.6, 95% CI (19.3- 69.0), p=0.022. Conclusion(s): We provide preliminary data that high efficacy DMTs may increase the risk of abnormal CSTs over time. A larger cohort and inclusion of additional cervical dysplasia risk factors are required to fully elucidate risk in wwMS.