Optimizing outcomes in multiple sclerosis: consensus guidelines for the diagnosis and treatment of multiple sclerosis in Latin America

Abstract

Abstract:Objective: The prevalence of multiple sclerosis (MS) in Latin America varies across different studies but an intermediate risk and increased frequency of the disease have been reported in recent years. The circumstances of Latin American countries are different from those of Europe and North America, both in terms of differential diagnoses and disease management. Methods: An online survey on MS was sent to 855 neurologists in nine Latin American countries. A panel of nine experts in MS analyzed the results. Results: Diagnostic and therapeutic recommendations were outlined with special emphasis on the specific needs and circumstances of Latin America. The experts proposed guidelines for MS diagnosis, treatment, and follow up, highlighting the importance of considering endemic infectious diseases in the differential diagnoses of MS, the identification of patients at high risk of developing MS in order to maximize therapeutic opportunities, early treatment initiation, and cost-effective control of treatment efficacy, as well as global assessment of disability. Conclusions: The experts recommended that healthcare systems allocate a longer consultation time for patients with MS, which must be conducted by neurologists trained in the management of the disease. All drugs currently approved must be available in all Latin American countries and must be covered by healthcare plans. The expert panel supported the creation of a permanent forum to discuss future clinical and therapeutic recommendations that may be useful in Latin American countries.

Sub-analysis of geographical variations in the 2-year observational COPTIMIZE trial of patients with relapsing–remitting multiple sclerosis converting to glatiramer acetate

“…For example, GA and IFN-β are typically the first-line treatment options in MS treatment algorithms, regardless of the geographical region [ 11 ]. However, some LA neurologists prescribe azathioprine because of limited DMT access or because the drugs are unavailable on healthcare plans [ 16 , 17 ]. Expert guidance on the specific steps of a conversion have begun to be published, suggesting a conversion in therapy may be considered when there is a high level of concern about relapse rates, progression of MS and magnetic resonance imaging outcomes, a medium level of concern about any two factors, or a low level of concern about all three factors [ 10 ].…”

“…These discrepancies may be due to differences in healthcare standards and environmental factors between the different regions. For example, the US, Canada, and LA have clinical treatment guidelines that vary in the topics discussed and the use of GA, IFN-β, natalizumab, dalfampridine, and fingolimod [ 10 , 16 – 18 ]. Also, it is possible that patients from different regions may have different epidemiological characteristics and comorbidities [ 16 ].…”

“…For example, the US, Canada, and LA have clinical treatment guidelines that vary in the topics discussed and the use of GA, IFN-β, natalizumab, dalfampridine, and fingolimod [ 10 , 16 – 18 ]. Also, it is possible that patients from different regions may have different epidemiological characteristics and comorbidities [ 16 ]. These regional differences cannot be adjusted in such a study, where the observational, non-interventional design carries inherent analytical limitations.…”

“…Briefly, this post-hoc subgroup analysis attempted to describe any variation in results that might exist between three predefined geographical areas: LA (Argentina, Brazil, Chile, Mexico, Venezuela), CWE (Belgium, Canada, Denmark, France, Greece, Ireland, Portugal, Netherlands, Norway, Sweden), and EE (Hungary, Romania, Slovakia). Countries were grouped into regions based on similarity of healthcare systems, physician approaches [ 15 ], available treatment options [ 10 , 16 ], and epidemiological characteristics of the population (disease prevalence, demographics, etc.) [ 2 ].…”

Guidelines of the Brazilian Society of Bone Marrow Transplantation on hematopoietic stem cell transplantation as a treatment for the autoimmune diseases systemic sclerosis and multiple sclerosis

“…The group studied patients not responsive to conventional therapy and who had disease progression. Two types of conditioning were studies: BEAM/ATG and cyclophosphamide/ATG (101) . In this protocol, 41 autologous transplants were performed.…”