Background

Teriflunomide, is an approved treatment for relapsing-remitting multiple sclerosis (RRMS) . The mechanism of action is not fully elucidated yet.

Objectives

The main goal of this study was to identify the changes in blood immune cells in clinical practice that can predict a better response to treatment.

Methods

RRMS patients who initiated teriflunomide treatment were included in the study. We studied peripheral blood cells obtained before and 6 months after treatment initiation.

Patients were classified in two groups: no evidence of disease activity (NEDA) or ongoing disease activity (ODA) after a year of follow-up.

Wilcoxon matched pair tests were used to assess differences between basal and 6 months after treatment results. Correlations were assessed by Mann–Whitney test. P-values below 0.05 were considered as significant.

Results

A total of 51 RRMS patients (31 females and 20 males) were included in this study. The mean age at the start of teriflunomide was 41 years. Baseline EDSS was 1.80. 18 patients were treatment naive, 15 switched from interferon-β, 15 from glatiramer acetate and 3 from experimental treatments. After a year on teriflunomide treatment, 35 patients showed NEDA and 16 ODA.

We studied changes between basal and 6-month sample. We observed a decreases for the lymphocytes, 75% for ODA (p = 0.004) and 57.14% for NEDA (p= 0.034). They showed a clear decrease for leukocytes 75% for ODA (p = 0.021) and 71.43% for NEDA (p= 0.047). We observed a moderate increase of monocytes in NEDA patiens 40% (p =0.314) and mild increase of monocytes in ODA patients 25% (p = 0.755).

Conclusions

We observe that teriflunomide induces changes in blood immune cells. It was shown a decrease in leukocytes and lymphocytes in both groups and a moderate increase in monocytes in patients with NEDA that we did not find in ongoing disease activity patients.

We did not find a statistically significant correlation between analytical values ​​and response to treatment.

Background

Sex hormonal variations and age have an influence in the course of the disease. MS patients are getting older and MS and menopausal symptoms could be overlapped and reduce the quality of life of the patients. Therefore is a great need to study the impact of menopause in MS patients.

Objectives

To study menopausal symptoms in MS women, the overlap with the MS symptoms and the influence of the menopause in the disease evolution and the quality of life.

Methods

Retrospective study. MS women with perimenopause and menopause (no more than 5 years) were recruited from our center. We collected demographic information, menarche, DMTs, quality of life, MS and menopause symptoms.

Results

30 patients were included, 15 in perimenopause (mean age 48) and 15 in menopause (mean age 49). 40% of all patients have a decrease of quality of life and increase of depressive symptoms, 50% reported worsening of the disease comparing with the non menopause period.

Most frequent symptoms in menopause MS patients were: Hot flashes (85%), vaginal dryness (70%), weight increase (60%) and adverse mood (60%). 85% of patients have no changes in fatigue, pain, spasticity and urinary symptoms. 31% of patients with menopause reported a worsening of the disease progression. Differences in number of children, menarche, obesity and smoking status have no correlation with an increase of menopausal symptoms. No association between DMTs and worsening or improving menopausal symptoms.

Conclusions

As stated above there is no increase in typical MS symptoms in these patients , however menopausal symptoms are present in most of them, leading to report a worsening in the disease and their well-being. Therefore, it is important to recognize the menopausal symptoms and to treat them to improve the quality of life and well being of our patients.

Background

There are some controversies about the neonatal anthropometric measures of infants born to MS mothers. Some studies reported a reduction of the head circumference at birth of newborns of MS mothers, which has been associated with developmental delay in other pathologies.

Objectives

To compare head circumference (HC) at birth of newborns of MS mothers with head circumference of newborns of healthy mothers.

Methods

Prospective study in pregnant women and their offsprings. Gestational age and head circumference were analyzed applying 3 different references standards.

Results

We studied 76 women and 96 pregnancies, 90 deliveries and 6 still ongoing. Mean maternal age was 35 ±4 years.

We studied 92 newborns and after excluding preterm and posterm, we analyzed neonatal head circumference of 83 term newborns, 45 girls and 38 boys and mean gestational age of 39.4 ±1 weeks.

Male infants mean HC at birth was 34.8 cm ±1,28 compared with WHO 50th percentile reference of 34.5 cm (p 0.07). Female mean birth HC was 34.6 cm ±0,99, larger than WHO reference of 33.9 cm (p <0.05).

Applying worldwide, the most accepted charts in neonatal centers, Olsen et al. growth curves, that include gender-specific HC-for age curves from infants aged 22 to 42 weeks at birth, we found 9 male infants born at 38 weeks with a mean HC of 34.4 cm ±1.16 the same as the Olsen charts (OC); 13 born at 39 weeks HC mean: 35.3 cm ±1.47 larger than OC (34.6 cm) p 0.12; 8 born at 40 weeks and 6 at 41 weeks HC mean: 34.8 cm ±1.00 and 35.0 cm ±1.55 respectively, the same as the OC in both ages. Analyzing female infants we found; 12 female infants born at 38 weeks with a mean HC of 34.4 cm ±0.76 larger than OC (33.7 cm) p 0.08; 10 born at 39 weeks HC mean: 34.7 cm ±1.11 larger than OC (34.0 cm) (p 0.07); 10 born at 40 weeks HC mean: 34.6 cm ±0.91 compared to 34.3 in OC (p 0.32) and 6 at 41w HC mean: 35.2cm ±0.94 larger than OC charts (34.5 cm) p 0.11.

Spanish pediatric centers usually used the charts of the Orbegozo Foundation^,as standard reference. Comparing our cohort and 50th percentile of the Orbegozo Foundation (35.19 cm ±1.14 for male and 34.48 cm ±1.16 for female) there were no significant findings.

Conclusions

We hence conclude that there were no statistically significant differences in the mean head circumference at birth in newborns of MS mothers compared to different references standard. It is worth highlighting that in order to compare anthropometric measurements in newborns it is crucial to apply standards references that include sex, gestational age and if possible national growth standards to avoid bias, which ultimately are lacking in the WHO standards.

Background

Teriflunomide, is an approved treatment for relapsing-remitting multiple sclerosis (RRMS) . The mechanism of action is not fully elucidated yet.

Objectives

The main goal of this study was to identify the changes in blood immune cells in clinical practice that can predict a better response to treatment.

Methods

RRMS patients who initiated teriflunomide treatment were included in the study. We studied peripheral blood cells obtained before and 6 months after treatment initiation.

Patients were classified in two groups: no evidence of disease activity (NEDA) or ongoing disease activity (ODA) after a year of follow-up.

Wilcoxon matched pair tests were used to assess differences between basal and 6 months after treatment results. Correlations were assessed by Mann–Whitney test. P-values below 0.05 were considered as significant.

Results

A total of 51 RRMS patients (31 females and 20 males) were included in this study. The mean age at the start of teriflunomide was 41 years. Baseline EDSS was 1.80. 18 patients were treatment naive, 15 switched from interferon-β, 15 from glatiramer acetate and 3 from experimental treatments. After a year on teriflunomide treatment, 35 patients showed NEDA and 16 ODA.

We studied changes between basal and 6-month sample. We observed a decreases for the lymphocytes, 75% for ODA (p = 0.004) and 57.14% for NEDA (p= 0.034). They showed a clear decrease for leukocytes 75% for ODA (p = 0.021) and 71.43% for NEDA (p= 0.047). We observed a moderate increase of monocytes in NEDA patiens 40% (p =0.314) and mild increase of monocytes in ODA patients 25% (p = 0.755).

Conclusions

We observe that teriflunomide induces changes in blood immune cells. It was shown a decrease in leukocytes and lymphocytes in both groups and a moderate increase in monocytes in patients with NEDA that we did not find in ongoing disease activity patients.

We did not find a statistically significant correlation between analytical values ​​and response to treatment.