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Background: Multiple Sclerosis (MS) is a chronic inflammatory disease of the central nervous system requiring complex diagnostic and therapeutic management. Treatment with Disease Modifying Drugs (DMDs) is aimed at reducing relapse rate and disease disability. Few real-world, population-based data are available on the impact of adherence on relapse rate. The objective of this study was to assess the impact of adherence to DMDs on relapses in a real-world Italian setting., Methods: Population-based cohort study. People with MS (PwMS) older than 18 years and residing in the Emilia-Romagna region, Northern Italy, were identified through administrative databases using a validated algorithm. A Cox regression model with a time-varying exposure was performed to assess the association between level of adherence to DMDs and relapses over a 5-year period., Results: A total of 2,528 PwMS receiving a first prescription of DMDs between 2015 and 2019 were included (average age of 42, two-thirds female). Highly adherent PwMS had a 25 % lower hazard of experiencing moderate or severe relapses than non-adherent PwMS (Hazard Ratio 0.75, 95 % CI 0.58 to 0.98), after adjusting for age and sex. Several sensitivity analyses supported the main result., Conclusion: The results of our study support the hypothesis that a high level of DMD adherence in MS is associated with a lower risk of moderate or severe relapse. Therefore, choosing the DMD with which to start drug treatment and recommending adherence to treatment appear to be crucial aspects involving both physicians and patients., Competing Interests: Declaration of Competing Interest The authors declare that there is no conflict of interest., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Introduction: The emergence of several therapeutic options in multiple sclerosis (MS), which significantly modify the immune system functioning, has led to the need for the consideration of additional factors, such as risk of infections, in the decision-making process. The aim of these consensus recommendations was to discuss and perform a practical guide to Latin American neurologists on the risk of infections at diagnosis, follow-up and prior to initiation of DMDs., Methods: A panel of Latin American neurologists, experts in demyelinating diseases and dedicated to management and care of MS patients, gathered during 2021 and 2022 to make consensus recommendations on the risk of infections in PwMS treated with DMDs in Latin America. The RAND/UCLA methodology was developed to synthesize the scientific evidence and expert opinions on health care topics and was used for reaching a formal agreement., Results: Recommendations were established based on relevant published evidence and expert opinion, focusing on: 1- baseline infection disease and vaccination status; 2- opportunistic infections; 3- progressive multifocal leukoencephalopathy; 4- genitourinary system infections; 5- respiratory tract infections; 6- digestive system infections, 7-others local infections and 8- COVID-19., Conclusion: The recommendations of this consensus seek to optimize the care, management and treatment of PwMS in Latin America. The standardized evidence-based care of pwMS infections will allow better outcomes., Competing Interests: Declaration of Competing Interest BAS has received personal compensation for consulting, congresses, serving on a scientific advisory board, speaking, or other research activities with Biogen-Idec, Genzyme, Merck-Serono, Novartis, Teva, Roche, Bristol Myers Squibb, LACTRIMS, International Society For Neurochemistry, International Brain and Research Organization. ECC has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Biogen-Idec, Genzyme, Merck-Serono, Novartis, Teva, Roche, LACTRIMS and the Guthy-Jackson Charitable Foundation. RA has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Biogen-Idec, Genzyme, Merck-Serono, Novartis, Bristol Myers Squibb, Janssen, Roche and LACTRIMS. PAL has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Biogen-Idec, Genzyme, Merck-Serono, Novartis, Bristol Myers Squibb, Raffo, Roche, Teva, and LACTRIMS. MFF has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Biogen-Idec, Merck-Serono, Novartis, Teva. MFF is CEO and co-founder of Entelai LLC. OG has received personal compensation for consulting, congresses, serving on a scientific advisory board, speaking, or other research activities with Biogen-Idec, Merck-Serono, Novartis, Roche, Bristol Myers Squibb, LACTRIMS, Synthon Bago, Raffo. Rest of the authors had nothing to disclose., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Background: There is limited information on the trajectories of disease-modifying therapy (DMT) use and their association with sickness absence and/or disability pension (SADP) among people with multiple sclerosis (PwMS). The objective of the study was to identify trajectories of DMT use over 10 years among PwMS, identify sociodemographic and clinical factors associated with the trajectories, and to assess the association between identified trajectories and SADP days., Methods: A longitudinal register-based study was conducted, on a prospective data set linked across six nationwide registers, assessing treatment courses of PwMS with DMTs for the 10 years following multiple sclerosis (MS) onset. The study included 1923 PwMS with MS onset in 2007-2010, when aged 19-56 years. In each 6-month-period, their treatment was categorized as before treatment, high-efficacy, non-high-efficacy, or no DMT. Sequence analysis was performed to identify sequences of the treatment categories and cluster them into different DMT trajectories. Cluster belonging, in relation to demographic and clinical characteristics, was assessed through log-multinomial regression analysis. The association of trajectories/cluster-belonging with SADP net days was assessed using generalized estimating equation (GEE) models., Results: Cluster analyses identified 4 trajectories of DMT use: long-term non-high-efficacy DMTs (38.6%), escalation to high-efficacy DMTs (31.2%), delayed start and escalation to high-efficacy DMTs (15.4%), and discontinued/ no DMT (14.2%). Age, MS type, expanded disability status scale (EDSS) score and the number of DMT switches were associated with cluster belonging. The youngest age group (18-25) were more likely to be in the escalation to high-efficacy cluster. People with primary progressive MS were more likely to be in the delayed start or discontinued/ no DMT cluster. Higher EDSS scores were associated to being in the other three clusters than in the long-term non-high-efficacy DMTs cluster. Higher number of DMT switches were associated with being in the escalation to high-efficacy DMTs cluster but less likely to be in the delayed start or discontinued/ no DMT clusters. Descriptive analyses showed a trend of fewer mean SADP days among PwMS using non-high-efficacy DMT than the other clusters about 9 years after onset. PwMS in the escalation to high-efficacy and discontinued/no DMT clusters had more SADP days. PwMS in the delayed start and escalation to high-efficacy DMTs cluster, started with fewer SADP days which increased over time. SADP days adjusted through GEE models showed trends comparable with the descriptive analysis., Conclusion: This study described the long-term real-world trajectories of DMT use among PwMS in Sweden using sequence analysis and showed the association of the trajectories with SADP days as well as sociodemographic and clinical characteristics., Competing Interests: Declaration of Competing Interest FST: funded partly by unrestricted research grant from Biogen and Celgene/Bristol-Myers Squibb. AM: funded partly by unrestricted research grant from Biogen. CM: funded partly by unrestricted research grant from Biogen AH: declares no conflicting interests. KF: received honoraria for serving on advisory boards for Biogen, Merck, Roche and speaker's fees from Merck. HG: was employed by IQVIA; a contract research organization that performs commissioned pharmacoepidemiological studies, and therefore was collaborating with several pharmaceutical companies; previously funded partly by an unrestricted research grant from Biogen. AG: has received research support from Novartis. KA: had unrestricted research grants from Biogen. JH: received honoraria for serving on advisory boards for Biogen and Novartis and speaker's fees from Biogen, Merck-Serono, Bayer-Schering, Teva, and Sanofi-Aventis. He has served as PI for projects sponsored by, or received unrestricted research support from, Biogen, Merck-Serono, TEVA, Novartis, and Bayer-Schering. JH's MS research is also funded by the Swedish Research Council. EF: funded partly by unrestricted research grant from Biogen, and has received unrestricted research grants from Celgene/Bristol-Myers Squibb., (Copyright © 2022 The Author(s). Published by Elsevier B.V. All rights reserved.)

Background: Neutropenia is an infrequent complication of treatment with CD20 depleting agents and may require the administration of granulocyte-colony stimulating factors (G-CSF), which have been associated with an increased relapse risk in patients with multiple sclerosis (PwMS). The management of this side effect is still matter of debate., Methods: Aim of this study is to evaluate the clinical features and the management of neutropenia occurring in anti-CD20 treated PwMS through a single-center case series and a systematic review of the literature, performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines., Results: A total of 19 patients were included (3 from our clinical experience, 16 from the systematic review). Median age was 38 years-old (25-69) and nearly 70% were female, most of these patients had already received a median of 3 (0-4) previous treatments. Neutropenia occurred in 11 patients treated with ocrelizumab and 8 with rituximab, after a median of 2 (1-7) infusions and 9.5 (1-42) months from the first infusion. Most of these patients had late-onset neutropenia, that occurred after a median time of 90 days (2-156). About 70% of patients were symptomatic and most were treated with G-CSF or antibiotics. No relapses after G-CSF were reported. In those who did not suspend anti-CD20 (68.8%), neutropenia reoccurred in 18.2% of cases. Finally, switching between rituximab and ocrelizumab seem not to affect the occurrence of neutropenia., Conclusion: Our data provides practical evidence regarding the occurrence and the management of neutropenia during treatment with anti-CD20 in PwMS., Competing Interests: Declaration of Competing Interest L Rossi has nothing to disclose. A Dinoto has nothing to disclose. A Bratina has received funding for travel and/or speaker honoraria from Almirall. S Baldini has received funding from Merk. F Pasquin has received funding for travel from Genzyme. A Bosco has received funding for travel and/or speaker honoraria from Teva, Biogen and Genzyme. A Sartori has received funding for travel honoraria from Novartis, Teva, Merk, Genzyme, Roche, Biogen. P Manganotti has nothing to disclose, (Copyright © 2022. Published by Elsevier B.V.)

Background: Lymphopenia is a common side effect of treatment with dimethyl fumarate (DMF) in patients with multiple sclerosis (PwMS). Prevalence and predictive factors of this side effect are still uncertain, because literature has provided discrepant results and it is still a matter of debate if lymphopenia is associated with a better treatment outcome., Methods: We retrospectively recruited PwMS treated for at least one month with DMF and collected clinical, demographic data and absolute lymphocyte count (ALC) during follow-up. Lymphopenia was graded according to CTCAE. Patients according to the grade in lymphopenia (all grades) and severe lymphopenia (grade II-IV). To evaluate predictors of lymphopenia, we compared characteristics of patients with/without lymphopenia and patients with/without severe lymphopenia. A logistic binary regression was performed to elucidate any predictive factor of lymphopenia and severe lymphopenia. Area under the curve (AUC) was calculated to evaluate sensibility and specificity of predictors. We analyzed treatment outcome with NEDA-3 status at 1- and 2-years., Results: 98 of 105 patients treated with DMF were included. 46.9% developed lymphopenia, 27.6% severe lymphopenia. Lymphopenia was associated with basal ALC (p<0.001, AUC=0.786), treatment duration (p = 0.01, AUC=0.685),% of reduction at third month (p = 0.001, AUC=0.616) Severe lymphopenia was associated with basal ALC (p = 0.003, AUC=0.750).NEDA-3 status at 1-year (n = 66) and at 2-year (n = 44) did not differ in patients with/without lymphopenia (p = 0.059; p = 0.583) or with/without severe lymphopenia (p = 1.02; p = 0.169)., Conclusion: Lymphopenia is a common side effect of DMF and basal ALC predicts its development. Lymphopenia is not associated with the achievement of NEDA-3 status., (Copyright © 2021. Published by Elsevier B.V.)

Background: Seminal trials evaluating anti-CD20 therapy in progressive MS primarily found benefit in younger, less-disabled patients with more inflammatory disease activity. The risks and benefits of ocrelizumab use in older patients with progressive froms of MS are not known., Methods: Retrospective chart review was performed for patients older than 55 with primary or secondary progressive MS at the time of ocrelizumab initiation. Clinical endpoints from 2 years prior to anti-CD20 therapy served as a within-subject control., Results: Data was reviewed for 56 patients older than the age of 55 at the time of ocrelizumab initiation. Of 37 patients with 2-years of follow up on ocrelizumab, 40%(n=15) experienced confirmed disability progression (CDP) while 60% (n=22) remained stable or improved. 24 patients had data available for the within-subject control; for these patients, median age was 67, baseline EDSS 6.3, and disease duration 20.5 years. Prior to anti-CD20 therapy, 58% (n=14) of patients remained stable and 42% (n=10) experienced CDP. After ocrelizumab initiation, 71% (n=17) remained stable and 29% (n=7) experienced CDP. There was no difference between CDP (p=0.54) or change in EDSS (p=0.09) between time periods. Ocrelizumab was well tolerated and no difference in infection rate was seen using the within-subject control., Conclusions: We found no difference in clinical endpoints for patients on ocrelizumab compared to prior to anti-CD20 therapy; however, we could not exclude a modest effect given our sample size. Larger trials are needed to evaluate ocrelizumab use in this understudied MS subpopulation., (Copyright © 2021. Published by Elsevier B.V.)

Background: Multiple sclerosis (MS) is the most common chronic immune-mediated neurological disorder in young adults, more frequently found in women than in men. Therefore, pregnancy-related issues have become an object of concern for MS professionals and patients. The aim of this work was to review the existing data to develop the first Argentine consensus for family planning and pregnancy in MS patients., Methods: A panel of expert neurologists from Argentina engaged in the diagnosis and care of MS patients met both virtually and in person during 2019 to carry out a consensus recommendation for family planning and pregnancy in MS. To achieve consensus, the procedure of the "formal consensus-RAND/UCLA method" was used., Results: Recommendations were established based on published evidence and expert opinion focusing on pre-pregnancy counseling, pregnancy, and postpartum issues., Conclusion: The recommendations of these consensus guidelines are intended to optimize the management and treatment of MS patients during their reproductive age in Argentina., Competing Interests: Declaration of Competing Interest Nora Fernández Liguori has received consulting fees from Biogen Argentina, Novartis Argentina and Genzyme Argentina, as a lecturer from Merck Argentina, Novartis Argentina, Genzyme Argentina and Biogen Argentina, and collaboration for attendance to national and international congresses from Biogen Argentina, Novartis Argentina, Merck Argentina, Bayer Argentina, Gador and Roche Argentina. Ricardo Alonso has received personal compensation for consulting, serving on a scientific advisory board, speaking, professional travel/accommodation stipends or other activities with Biogen Argentina, Genzyme Argentina, Merck Argentina, Novartis Argentina and Roche Argentina. María Eugenia Balbuena has received personal compensation for speaking from Roche, professional travel/accommodation stipends from Merck, Novartis and Teva and funding for research from Genzyme and Novartis. Andrés Barboza has received reimbursement for developing educational presentations, educational and research grants, consultation fees and travel stipends from Biogen, Sanofi, Merck, Roche, Novartis, Teva, Gador, Raffo, Biosidus and Synthon-Bagó. Santiago Bestoso has received personal compensation for speaking, professional travel/accommodation stipends or other activities from Merck, Biogen, Novartis, Gador and Genzyme. Marcos Burgos has received personal compensation for speaking from Merck, Novartis, Raffo, Sanofi Genzyme, Biogen, Roche and for research from Novartis and Biogen. Fernando Cáceres has received fees for being a member of advisory boards, for research, being a speaker and for traveling/accommodation for scientific medical meetings of the following companies: Novartis, Teva, Roche, Biogen, Sanofi Genzyme and Merck. Edgar Carnero Contentti has received personal compensation for consulting, serving on a scientific advisory board, speaking, professional travel/accommodation stipends or other activities with Biogen Argentina, Genzyme Argentina, Merck Argentina, Novartis Argentina, Teva Argentina, Roche Argentina and Bayer Argentina. Adriana Carrá has received personal compensation for consulting, serving on a scientific advisory board, speaking, professional travel/accommodation stipends or other activities with Bayer; Biogen; Biosidus; Genzyme; Merck; MS Synthon-Bago; Novartis; Roche; Teva, Tuteur. Edgardo Cristiano received consulting fees, funding for advisory boards and educational support from Biogen, Genzyme, Merck, Novartis and Roche. Norma Deri has received personal compensation for advisory boards for Bayer Argentina, Bayer Latinoamerica, Bayer Global, Merck Serono Argentina, Merck Serono Global, Genzyme Argentina, Genzyme Latinoamerica, Genzyme Global and Sanofi Global; for travel/ accommodation from Schering, Bayer, Serono, Merck Serono, Novartis, Biogen Idec, Teva-Tuteur, Teva and Roche; for research from Bayer Argentina, Biogen Idec Argentina,Genzyme Argentina, Novartis Argentina, Roche Argentina, Teva Argentina and Sanofi Argentina and for educational presentations from Bayer Argentina, Merck Serono Argentina and Genzyme Argentina. Marcela Fiol has received personal compensation for developing educational presentations, serving on a scientific advisory board from Merck-Serono Argentina, Sanofi Genzyme Argentina, TEVA-Tuteur Argentina and has received travel/accommodations stipends from Merck-Serono Argentina, Sanofi Genzyme Argentina, Biogen INC, Bayer Inc, Novartis, TEVA-Tuteur Argentina, ROCHE Argentina. María Inés Gaitán has received reimbursement for developing educational presentations, from Roche Argentina, Merck Argentina, Biogen Argentina, Sanofi-Genzyme Argentina, Bayer Inc Argentina and Novartis Argentina, and has received travel/accommodations stipends from Merck Argentina, Biogen Argentina, Roche Argentina, Novartis Argentina, and TEVA Argentina. Orlando Garcea has received personal compensation for consulting and speaking from Bayer, Merck, Biogen, Novartis and Genzyme. Mario Javier Halfon has received personal compensation for consulting, serving on a scientific advisory board, speaking, professional travel/accommodation stipends or other activities from Biogen Argentina, Merck Argentina, Roche, Gador, Novartis, and Genzyme Argentina. Javier Hryb has received honoraria for the development of educational activities, and travel grants to congresses from Teva, Merck, Biogen, Roche, Tuteur, Synthon Bago and Novartis. Miguel Jacobo has received honoraria for the development of educational activities, research and travel grants to congresses from Biogen, Roche, Merck, Genzyme Novartis, Teva, Bayer, Raffo and Gador. Eduardo Knorre has received personal compensation for professional travel/accommodation stipends or other activities from Bagó, Tuteur and Roche. Pablo López has received personal compensation for consulting, serving on scientific advisory boards, speaking, professional travel/accommodation stipends or other activities with Biogen, Genzyme, Merck-Serono, Novartis, Teva, Roche and Bayer. Jimena Miguez has received personal compensation for professional travel/accommodation stipends or other activities from Merck, Novartis, Genzyme, Roche and for speaking from Merck, Novartis and Roche. Pedro Nofal has received honoraria for the development of educational activities, research and travel grants to congress from Novartis, Biogen, Merck Serono, Raffo, Genzyme, Gador and Bayer Schering. Raúl Piedrabuena has received personal compensation for the development of educational activities, serving on a scientific advisory board and research from Biogen, Merck, Novartis, Genzyme, Roche and Teva. Cecilia Pita has received honoraria for the development of educational activities, research and travel grants to congress from Biogen, Genzyme, Merck, Novartis and Roche. Juan Ignacio Rojas has received reimbursement for developing educational presentations, educational and research grants, consultation fees and travel stipends from Biogen, Genzyme, Merck, Novartis. Berenice Silva has received economic retribution for the development of educational, scientific activities and travel grants to congresses from Biogen, Novartis, Merck, Genzyme, TEVA, Bayer, Tuteur and Roche. Vladimiro Sinay has received personal compensation for consulting, serving on a scientific advisory board, speaking, professional travel/accommodation stipends or other activities with Bayer, Biogen, Genzyme, Merck, Novartis, Roche, Biosidus, Gador, Tuteur and Raffo/ Asofarma. Adriana Tarulla reports personal fees for speaking and support for travel to meetings from Bayer,Biogen Idec,Biosidus,Gador,Ivax-Teva,Merck Serono and Roche, out-side the submitted work. Darío Tavolini has received personal compensation for consulting, serving on a scientific advisory board, speaking, professional travel/accommodation stipends or other activities Bayer, Biogen, Genzyme, Merck Serono, Novartis, Roche and Teva. Santiago Tizio has received professional travel accommodation stipends from Merck-Serono, Synthon Bago, Biogen-Idec, TEVA, Genzyme, Novartis and Roche; reimbursement for developing educational presentations from Biogen-Idec and Novartis and honoraria for advisory services from Merck-Serono, and Novartis. Verónica Tkachuk: has received personal compensation for consulting, serving on a scientific advisory board, speaking, professional travel/accommodation stipends or other activities from Biogen, Roche, Merck, TEVA, Sanofi Genzyme, Novartis, Bayer y Raffo. Carlos Vrech has received personal compensation for consulting, serving on a scientific advisory board, speaking, professional travel/accommodation stipends or other activities from Merck, Novartis, Biogen, Synthon Bago, Gador and Genzyme. Maria Célica Ysrraelit has received personal compensation for consulting, serving on a scientific advisory board, speaking, professional travel/accommodation stipends or other activities from Merck, Biogen, Novartis, Roche and Bayer Argentina. Liliana Patrucco has received speaker honoraria from Biogen, Genzyme, Merck-Serono, Novartis and Roche. Has received travel grants and attended courses and conferences on behalf of Merck-Serono, Genzyme and Roche. All the other authors have nothing to disclose., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Current multiple sclerosis (MS) therapeutic options have significantly increased treatment algorithm complexity. This urges physicians to take into account multiple factors in the decision-making process and make an even more thorough analysis of the risk-benefit balance. We carried out a descriptive review aiming to assess some factors that endanger the proper MS treatment fulfillment, focusing mainly on Latin American countries. Firstly, it is paramount to warrant the correct, fair and timely treatment access. We found that disease modifying drugs (DMDs) access is highly variable among different countries and even different regions within a country. In this sense less than 35% of MS patients in Latin American have access to treatment. Secondly, adherence depends on some characteristics such as the way of administration, treatment length and side effects, among others. Finally, chronic immune suppression has become a common consequence of most DMDs. Hence, the different mechanisms of action and their safety profile should be taken carefully into consideration when choosing a specific drug. These three areas of interest related to a single medication, adherence, access to it and mechanism of action, are of utmost importance when trying to achieve effectiveness instead of just efficacy., (Copyright © 2019. Published by Elsevier B.V.)

Background: Despite a recent interest in Real World Data, such studies are scarce in multiple sclerosis (MS) disease. The objective was to describe the patients, disease progression and use of DMDs in France and compare clinical effectiveness of first-line injectable DMDs., Methods: We conducted a retrospective multicenter study in France, using data collected by 11 expert centers with the EDMUS software., Results: Overall, 15,039 French MS patients were followed for a mean of 11.5 years. Mean age at start of disease was 32 years and 74% were women. After the disease onset, median time to reach EDSS 3 was 11 years and 51.8% of patients were relapse-free 2 years after the disease's onset. The mean delay between onset of disease and initiation of treatment was 5.7 ± 6.9 years. Over time, it decreased from 8.8 ± 7.8 to 0.7 ± 0.7 years for initiation of treatment before 2000 vs. after 2010, respectively. Two years after the initiation of treatment, the persistence rate of injectable disease modifying drugs (DMDs) was 60.7%. The effectiveness of these drugs were quite similar., Conclusion: This study brings new insight on the natural history of MS and the use and effectiveness of injectable DMDs in this condition., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Background: There is limited evidence about the optimal length of washout when switching from natalizumab to fingolimod., Objective: To study if a washout period of 4 weeks is associated with less disease activity compared to 8 weeks., Methods: 25 patients with Relapsing Remitting Multiple Sclerosis were included in an open label, prospective study with a follow-up of 108 weeks. The primary endpoint (PE) was defined as "time to first relapse or MRI disease activity up to week 56". In addition, a recurrent event analysis (REA) was performed up to week 108., Results: The PE was not met (HR 0.67, 95% CI [0.22,1.97], p = 0.462). Number of relapses before stopping natalizumab was positively associated with the hazard of relapse (HR 3.91, p = 0.0117, 95% CI [1.36, 11.28]). The REA showed a reduction of the hazard to develop a relapse by 77% (HR 0.23, 95% CI [0.08, 0.69], p = 0.00854) in favor of the cohort with 4 weeks washout., Conclusions: Our study suggests that switching from natalizumab to fingolimod with a shorter washout of 4 weeks might reduce the risk of disease reactivation after switching., (Copyright © 2018 The Author(s). Published by Elsevier B.V. All rights reserved.)

Background: The purpose of the survey was to assess the knowledge of family planning issues associated with disease modifying therapies (DMTs) among patients diagnosed with multiple sclerosis (MS)., Methods: 590 Danish MS patients responded to an online questionnaire about family planning in MS, collecting demographics, disease characteristics, disease modifying treatment, knowledge of potential teratogenic effects in DMTs, number of children, occurrence of unplanned pregnancies and outcome, and sources of information., Results: 488 females and 102 males, mean age 40 years, responded. On average, it was 6.5 and 10.9 years since diagnosis and first symptoms, respectively. 16% of female and 19% of male respondents did not receive DMT at the time of responding to the survey. 30% of all had received only one DMT, 37%, 19%, 8%, and 5% had received two, three, four, and five different treatments, respectively. 42% of female and 74% of male respondents said they did not know if the medication they were taking had teratogenic risks. 83% of females and 85% of males responded that they did not know, whether DMT in male MS patients may expose healthy partners to teratogenic risks; hereto, 13% and 10%, respectively, answered that no transmission occurs. On average respondents had two children; three of four children reported in the study were born prior to the respondents being diagnosed with MS. 50% of both female and male respondents without children wanted a family and 25% of females and 16% of males wanted to start a family within the next two years. 91% of female respondents would discontinue DMT during pregnancy. Among male respondents 32% would continue treatment during a partner's pregnancy and 47% did not know whether they would continue or discontinue treatment. 10% of the female patients had had unplanned pregnancies during MS treatment, of these 49% chose to have an abortion. 53% of all felt they were well informed about MS treatment and family planning. 22% and 41% of the respondents received information from the neurologist about teratogenic risks in female MS patients and about teratogenic risks in women with male MS patients as partners, respectively; 27% and 34%% retrieved information from the internet on these two issues., Conclusion: This survey uncovered a low level of knowledge about DMTs' teratogenic risks among MS patients irrespective of sex. Knowledge about potential teratogenic risks for male MS patients receiving DMTs while planning to start a family was largely absent. 10% of female patients had experienced unplanned pregnancies on MS treatment. In general, patients use the internet and their neurologist to the same extent for information on parenthood planning., (Copyright © 2018 The Authors. Published by Elsevier B.V. All rights reserved.)