Multiple Sclerosis: A Global Concern with Multiple Challenges in an Era of Advanced Therapeutic Complex Molecules and Biological Medicines

Abstract

Multiple sclerosis (MS) has become a common neurological disorder involving populations previously considered to be infrequently affected. Genetic dissemination from high- to low-risk groups is a determining influence interacting with environmental and epigenetic factors, mostly unidentified. Disease modifying therapies (DMT) are effective in treating relapsing MS in variable degrees; one agent is approved for primary progressive disease, and several are in development. In the era of high-efficacy medications, complex molecules, and monoclonal antibodies (MAB), including anti-VLA4 (natalizumab), anti-CD52 (alemtuzumab), and anti-CD20 (ocrelizumab), obtaining NEDA (no evidence of disease activity) becomes an elusive accomplishment in areas of the world where access to MS therapies and care are generally limited. Countries’ income and access to public MS care appear to be a shared socioeconomic challenge. This disparity is also notable in the utilization of diagnostic tools to adhere to the proposed elements of the McDonald Criteria. The impact of follow-on medications (“generics”); injectable non-biological complex drugs (NBCD), oral sphingosine-1-phosphate receptor modulators, and biosimilars (interferon 1-a and 1-b), utilized in many areas of the world, is disconcerting considering these products generally lack data documenting their efficacy and safety. Potential strategies addressing these concerns are discussed from an international point of view.

Quantifying the Metabolic Signature of Multiple Sclerosis by in vivo Proton Magnetic Resonance Spectroscopy: Current Challenges and Future Outlook in the Translation From Proton Signal to Diagnostic Biomarker

“…Multiple sclerosis is one such disease. With more than 2.3 million patients worldwide and a prevalence that appears to be rising in the United States (15) and potentially among ethnic groups historically considered to be low-risk (16), multiple sclerosis is a chronic autoimmune condition that targets the central nervous system, rendering it one of the most common causes of neurological disability in young adults (17). Its diagnosis continues to depend on the subjective and uncertain (18) multifactorial synthesis of symptom self-report, neurological evaluation, and magnetic resonance imaging for central nervous system lesions, in addition to lumbar puncture for assay of oligoclonal bands in the cerebrospinal fluid (19).…”

Barriers to access and utilization of multiple sclerosis care services in a large cohort of Latin American patients

“…[7][8][9]16 Access to a wide range of clinical specialists and complementary exams is critical to ensure health and QoL in this patient group. [17][18][19][20] Data from the Atlas of MS 2013 17 are more robust than in 2008. The most recent survey reported health care and support services had improved, with increased numbers of neurologists and MRI scans available worldwide, including in emerging countries from LATAM.…”

Circulating nucleic acids in the plasma and serum as potential biomarkers in neurological disorders

“…Multiple sclerosis is an immune-mediated disorder that leads to demyelination of axons in the CNS. Its prevalence is variable depending on the geographic region; it ranges from 50–400 per 100,000 inhabitants ( 66 ). In multiple sclerosis, oligodendrocytes, cells that produce myelin in the CNS, die after an autoimmune response, an action that results in axon demyelination in the brain and spinal cord.…”