[Cladribine in the treatment of relapsing multiple sclerosis]. / Cladribina en el tratamiento de la esclerosis multiple recurrente.

Multiple sclerosis is a chronic neurological disease of the central nervous system where inflammation and neurodegeneration converge, inducing a disorder with both a progressive course and a high degree of disability. Multiple sclerosis usually begins between the ages of 20 and 40 and affects two to three times as many women as men. The main objective of pharmacological management is to reduce the inflammation and to delay the disability onset. Many of the currently available drugs have shown different degrees of efficacy associated to a specific adverse events profile. In routine clinical practice, an usual therapeutic approach is called escalation therapy; that is, starting with a moderate-efficacy treatment according to the clinical-radiological inflammatory profile, taking into account the patient's personal situation (pregnancy desire, fear of needles, prior comorbidity) and then move on to a high-efficacy treatment in case of suboptimal response. Thus, adverse events are minimized. However, many authors defend a more aggressive approach (induction therapy); that is, using high-efficacy treatments in the early stages to, after controlling the inflammation, move on to a moderate-efficacy treatment. Cladribine is an oral immunosuppressant recently approved in Europe for the treatment of highly active relapsing multiple sclerosis. Its effectiveness, comfort in posology and safety, make it an option not only for aggressive forms of the disease, but as a possible induction therapy.

TITLE: Cladribina en el tratamiento de la esclerosis multiple recurrente.La esclerosis multiple es una enfermedad neurologica cronica del sistema nervioso central, de etiologia desconocida y mecanismo autoinmune, en la que inflamacion y neurodegeneracion confluyen, originando un trastorno de curso progresivo con un alto grado de discapacidad. Predomina en mujeres y se diagnostica sobre todo entre los 20-40 años de edad. Actualmente, el objetivo del tratamiento farmacologico es disminuir la inflamacion e intentar retrasar la aparicion de discapacidad. En la practica clinica habitual, el abordaje terapeutico, como normal general, se basa en un modelo de escalado terapeutico; es decir, iniciando con un farmaco de eficacia moderada de acuerdo con el perfil clinicorradiologico de la enfermedad y teniendo en cuenta la situacion personal del paciente (deseo gestacional, miedo a las agujas, comorbilidades), para luego pasar a farmacos mas potentes en caso de respuesta suboptima. De esta forma se minimizan los efectos adversos. Sin embargo, muchos autores defienden un abordaje mas agresivo en el inicio de la enfermedad en algun subtipo de pacientes (terapia de induccion), es decir, utilizando farmacos mas activos en fases iniciales para, cuando la inflamacion este mas controlada, iniciar un farmaco de eficacia moderada. La cladribina es un inmunosupresor oral recientemente aprobado en Europa para el tratamiento de formas activas de esclerosis multiple recurrente. Su perfil de eficacia, comodidad en la posologia y seguridad la convierten en una opcion no solo para formas mas activas de la enfermedad, sino como terapia de induccion.

Cognitive impairment in early stages of multiple sclerosis is associated with high cerebrospinal fluid levels of chitinase 3-like 1 and neurofilament light chain.

BACKGROUND AND PURPOSE: Chitinase 3-like 1 (CHI3L1) and neurofilament light chain (NF-L) are promising biomarkers of disability in multiple sclerosis (MS). However, their role in cognitive dysfunction remains elusive. Here, we aimed to correlate cerebrospinal fluid (CSF) levels of CHI3L1 and NF-L with cognitive status in MS. METHODS: Fifty one recently diagnosed patients were cognitively evaluated and CSF was collected. Levels of CHI3L1 and NF-L were determined by ELISA. Spearman's partial correlation coefficient was performed. RESULTS: After adjusting cognitive scores by age, anxiety and EDSS, association was detected between CHI3L1 levels and Trail Making Test A (rs = 0.348; p = 0.016) and between NF-L levels and Word List Generation (rs = -0.324; p = 0.025). CONCLUSION: High levels of CSF CHI3L1 and NF-L are associated with cognitive impairment in the early phases of MS.