{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T11:41:41Z","timestamp":1792669301224,"version":"4.5.0"},"reference-count":37,"publisher":"SAGE Publications","issue":"12","license":[{"start":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T00:00:00Z","timestamp":1786579200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T00:00:00Z","timestamp":1786579200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Mult Scler"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:sec>\n                    <jats:title>Background\/Objectives:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>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).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>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\u2013172), cervical dysplasia (RR: 1.40, 95% CI: 1.31\u20131.49), cervical cancer (RR: 1.23, 95% CI: 1.03\u20131.46), cervicitis (RR: 1.25, 95% CI: 1.10\u20131.41), herpes simplex virus positivity (RR: 1.29, 95% CI: 1.14\u20131.45), vulvovaginitis (RR: 1.30, 95% CI: 1.23\u20131.37), and Bartholin cysts\/abscesses (RR: 1.37, 95% CI: 1.07\u20131.76). Moderate- to high- (vs low-) immunosuppressive.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/13524585261475100","type":"journal-article","created":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T07:44:01Z","timestamp":1786607041000},"page":"1315-1322","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Gynecologic complications of disease-modifying therapy in women with multiple sclerosis"],"prefix":"10.1177","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3202-6921","authenticated-orcid":false,"given":"Alexandra","family":"Balshi","sequence":"first","affiliation":[{"name":"Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John P","family":"Dempsey","sequence":"additional","affiliation":[{"name":"Norton College of Medicine, SUNY Upstate Medical University, Syracuse, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanli","family":"Zhang-James","sequence":"additional","affiliation":[{"name":"Norton College of Medicine, SUNY Upstate Medical University, Syracuse, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2034-8800","authenticated-orcid":false,"given":"Riley","family":"Bove","sequence":"additional","affiliation":[{"name":"UCSF Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,8,13]]},"reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp-2017-317493"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.semcancer.2013.11.002"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/s0029-7844(00)00948-0"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.3390\/jcm4020260"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000209885"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1212\/01.wnl.0000345366.10455.62"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000208059"},{"key":"e_1_3_4_9_2","doi-asserted-by":"publisher","DOI":"10.1212\/WN9.0000000000000025"},{"key":"e_1_3_4_10_2","doi-asserted-by":"publisher","DOI":"10.1177\/13524585251377411"},{"key":"e_1_3_4_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.msard.2024.105921"},{"key":"e_1_3_4_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.msard.2023.105387"},{"key":"e_1_3_4_13_2","doi-asserted-by":"publisher","DOI":"10.1177\/13524585251346371"},{"key":"e_1_3_4_14_2","doi-asserted-by":"publisher","DOI":"10.1002\/pds.70198"},{"key":"e_1_3_4_15_2","doi-asserted-by":"publisher","DOI":"10.1093\/jamiaopen\/ooad035"},{"key":"e_1_3_4_16_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2025.3011"},{"key":"e_1_3_4_17_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2025.2020"},{"key":"e_1_3_4_18_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamapsychiatry.2024.4465"},{"key":"e_1_3_4_19_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2024.2057"},{"key":"e_1_3_4_20_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.125.053599"},{"key":"e_1_3_4_21_2","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awae128"},{"key":"e_1_3_4_22_2","unstructured":"Cervical Cancer Causes Risk Factors and Prevention\u2014NCI 2022 https:\/\/www.cancer.gov\/types\/cervical\/causes-risk-prevention (accessed August 30 2025)."},{"key":"e_1_3_4_23_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000214509"},{"key":"e_1_3_4_24_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.40988"},{"key":"e_1_3_4_25_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamapediatrics.2024.3812"},{"key":"e_1_3_4_26_2","unstructured":"Hildebrand JP Carlson K Kansagor AT. 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