Cladribine is an oral immune reconstitution therapy for relapsing multiple sclerosis (RMS). Hormonal and immune changes are responsible for the decline of disease activity in the third trimester of pregnancy and disease reactivation in the early post-partum period.We investigate the impact of pregnancy on disease activity in women with MS who conceived after cladribine treatment. We recruited women of childbearing age with relapsing–remitting MS (RRMS) who became pregnant or not after being treated with cladribine. For both groups, demographic, clinical and radiological data were collected 1 year before and after treatment during a mean follow-up of 3.53 years. We compared disease activity over time between groups using variance analysis for repeated measures. 48 childbearing women were included. 25 women had a pregnancy after a mean of 1.75 years from the first treatment cycle. Women with or without pregnancy did not differ in demographics or pre-cladribine disease activity. No significant differences in disease activity or EDSS worsening were found between women with or without pregnancy. Our findings suggest that pregnancy does not appear to influence disease activity and disability in women previously treated with cladribine; further studies with larger numbers and longer follow-up are needed to confirm this finding.

Introduction Multiple Sclerosis (MS) manifests with a plethora of signs and symptoms affecting brain structures and spinal pathways. The multitude of lesions in MS patients makes difficult to establish the relative role of each of them to lower urinary tract symptoms (LUTS). Generally, the subcortical white-matter lesions result in detrusor overactivity, whilst lesions of the spinal cord result in the combined occurrence of detrusor overactivity and detrusor-sphincter dyssynergia (DSD). It has been estimated that 80-90% of patients with MS will suffer from some form of LUTS over the course of the disease. Among LUTS, the most reported is detrusor overactivity which includes urinary urgency, frequent urination, nocturia, and urge urinary incontinence. Areas covered The authors review the management of lower urinary tract symptoms in MS patients providing their expert opinions on the subject matter. Expert opinion LUTS affect the quality of life substantially and are associated with a significantly increased mortality. The adequate management is an important challenge for both patients and caregivers with a multidisciplinary approach likely necessary.

The Multiple Sclerosis (MS) therapeutic scenario has radically changed in the last few years, due to new insights on disease pathogenesis and course. Although MS is considered a prototype of the central nervous system (CNS) diseases, the therapeutic possibilities are based primarily on immunomodulation and/or immunosuppression of peripheral immunotargets. Furthermore, communication between the immune system and the CNS is exemplified by crosstalk between glia and neurons, essential for maintaining homeostasis. Knowledge of the cross-talk between microglia and oligodendrocytes may continue to uncover novel pathways of immune regulation in the brain [1]. Classically MS was considered a T-cells mediated disease, but more recent evidence showed as B cells and other immune cells are actively involved [2,3]. Therefore, the deep use of immunotargets characterization before the beginning of any Disease Modifying Therapy (DMT) represents the future of MS therapy [4]. Treatment response has traditionally been based on clinical activity (relapse-rate), radiological activity/ burden at Magnetic Resonance Imaging, and level of disability measured by Expanded Disability Status Scale. Larger longitudinal data sets have enabled the development of composite outcome measures and more stringent standards for disease control. Biomarkers, including neurofilament light chain, have potential as early surrogate markers of prognosis and treatment response but require further validation [5,6]. Overall, apersonalized approach for MS which takes into account comorbidities and cognitive impairment is adesirable goal but new researches are necessary to define it. Therapeutic algorithms that can classify patients according to their personal risk of disease progression should be developed.

Teriflunomide (TRF) and Dimethyl fumarate (DMF) are licensed drugs for relapsing-remitting Multiple Sclerosis (RRMS).