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Rojas JI, Alonso R, Luetic G, Patrucco L, Casas M, Silva B, Miguez J, Deri N, Vrech C, Liwacki S, Piedrabuena R, Silva E, Tkachuk V, Burgos M, Tavolini D, Zanga G, Pinheiro AA, Hryb J, Leguizamon F, Knorre E, Lopez PA, Martinez A, Carrá A, Alonso Serena M, Cristiano E, Correale J, Garcea O, Fernandez Liguori N, Carnero Contentti E. Real-World Effectiveness and Safety of Cladribine in Multiple Sclerosis: Longitudinal Data From the Nationwide Registry in Argentina. Clin Neuropharmacol 2024; 47:120-127. [PMID: 39008542 DOI: 10.1097/wnf.0000000000000598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
OBJECTIVE The aim was to evaluate patient profiles, effectiveness and safety of cladribine (CLAD) in patients with relapsing-remitting multiple sclerosis in Argentina. METHODS This was a substudy included in RelevarEM (MS and neuromyelitis optica registry in Argentina, NCT03375177). Patients with MS who received CLAD tablets and were followed up for at least 24 months were included. Clinical evaluations every 3 months collect information about: a) clinical relapses; b) progression of physical disability, evaluated through Expanded Disability Status Scale, and c) new lesions found in the magnetic resonance imaging. Lymphopenia was evaluated during the follow-up and defined as grade 1: absolute lymphocyte count (ALC) 800-999/μL; grade 2: ALC 500-799/μL; grade 3: ALC 200-499/μL and grade 4: ALC <200/μL. RESULTS A total of 240 patients were included from 19 centers from Argentina. The mean annualized relapse rate during the 12-month pre-CLAD initiation was 1.19 ± 0.56 versus 0.22 ± 0.18 at month 12 and 0.19 ± 0.15 at month 24 ( P < 0.001). A total of 142 (59.2%) fulfilled the criteria of disease activity during the 12 months before treatment initiation, whereas 27 (11.3%) fulfilled it at month 12 and 38 (15.8%) at month 24, P < 0.001. Regarding no evidence of disease activity (NEDA), 202 (84.2%) patients achieved NEDA status at month 12 and 185 (77%) at month 24. The most frequent incidence density of lymphopenia for course 2 observed was also for grade 1, 6.1 (95% confidence interval [CI] = 5.5-7.1). The overall incidence density of lymphopenia grade 4 was 0.1 (95% CI = 0.06-0.19). CONCLUSION This information will help when choosing the best treatment option for Argentinean patients.
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Affiliation(s)
| | | | | | | | - Magdalena Casas
- Centro Universitario de Esclerosis Múltiple - Hospital Dr. J. M. Ramos Mejía, Facultad de Medicina - UBA, CABA, Argentina
| | | | - Jimena Miguez
- Servicio de Neurología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Norma Deri
- Centro de Investigaciones Diabaid, CABA, Argentina
| | - Carlos Vrech
- Departamento de Enfermedades desmielinizantes - Sanatorio Allende, Córdoba
| | | | | | - Emanuel Silva
- Predigma - Centro de Medicina Preventiva, Posadas, Misiones, Argentina
| | - Verónica Tkachuk
- Sección de Neuroinmunología y Enfermedades Desmielinizantes, Servicio de Neurología - Hospital de Clínicas José de San Martín, CABA, Argentina
| | - Marcos Burgos
- Servicio de Neurología - Hospital San Bernardo, Salta, Argentina
| | - Dario Tavolini
- INECO Neurociencias Oroño - Fundación INECO, Rosario, Santa Fe, Argentina
| | - Gisela Zanga
- Unidad asistencial César Milstein, CABA, Argentina
| | | | - Javier Hryb
- Servicio de Neurología - Hospital Carlos G. Durand, CABA, Argentina
| | | | - Eduardo Knorre
- Hospital de Agudos, Dr. Teodoro Álvarez, CABA, Argentina
| | - Pablo A Lopez
- Neuroimmunology Unit, Department of Neuroscience, Hospital Aleman, Buenos Aires, Argentina
| | - Alejandra Martinez
- Sección de Enfermedades Desmielinizantes - Hospital Británico, CABA, Argentina
| | - Adriana Carrá
- Sección de Enfermedades Desmielinizantes - Hospital Británico, CABA, Argentina
| | | | | | | | - Orlando Garcea
- Centro Universitario de Esclerosis Múltiple - Hospital Dr. J. M. Ramos Mejía, Facultad de Medicina - UBA, CABA, Argentina
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Nathoo N, Zeydan B, Neyal N, Chelf C, Okuda DT, Kantarci OH. Do magnetic resonance imaging features differ between persons with multiple sclerosis of various races and ethnicities? Front Neurol 2023; 14:1215774. [PMID: 37448745 PMCID: PMC10338060 DOI: 10.3389/fneur.2023.1215774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 06/12/2023] [Indexed: 07/15/2023] Open
Abstract
Those of African American or Latin American descent have been demonstrated to have more severe clinical presentations of multiple sclerosis (MS) than non-Latin American White people with MS. Concurrently, radiological burden of disease on magnetic resonance imaging (MRI) in African Americans with MS has also been described as being more aggressive. Here, we review MRI studies in diverse racial and ethnic groups (adult and pediatric) investigating lesion burden, inflammation, neurodegeneration, and imaging response to disease modifying therapy. We also discuss why such disparities may exist beyond biology, and how future studies may provide greater insights into underlying differences.
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Affiliation(s)
- Nabeela Nathoo
- Division of Multiple Sclerosis and Autoimmune Neurology, Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Burcu Zeydan
- Division of Multiple Sclerosis and Autoimmune Neurology, Department of Neurology, Mayo Clinic, Rochester, MN, United States
- Department of Radiology, Mayo Clinic, Rochester, MN, United States
| | - Nur Neyal
- Division of Multiple Sclerosis and Autoimmune Neurology, Department of Neurology, Mayo Clinic, Rochester, MN, United States
- Department of Radiology, Mayo Clinic, Rochester, MN, United States
| | - Cynthia Chelf
- Mayo Clinic College of Medicine and Science, Library-Public Services, Mayo Clinic, Rochester, MN, United States
| | - Darin T. Okuda
- Department of Neurology, The University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Orhun H. Kantarci
- Division of Multiple Sclerosis and Autoimmune Neurology, Department of Neurology, Mayo Clinic, Rochester, MN, United States
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Tkachuk V, Balbuena Aguirre ME, Alonso R, Barboza A, Liwacki SDV, Mainella C, Rojas JI, Silva BA, Tavolini D, Zanga G, López P, Delgado Garcia G, Carnero Contentti E. Barriers to access and unmet needs to neuromyelitis optica spectrum disorders care in an Argentinean cohort. Mult Scler Relat Disord 2023; 70:104485. [PMID: 36610362 DOI: 10.1016/j.msard.2022.104485] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 12/03/2022] [Accepted: 12/22/2022] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Neuromyelitis optica spectrum disorder (NMOSD) is a rare but severe neuroimmunological condition associated with a significant financial burden. NMOSD is also associated with increased health care utilization, including neurology outpatient visits, magnetic resonance imaging (MRI) use, long-term medication, among others. We aimed to evaluate real-world patient experiences in access to care and NMOSD burden in an Argentinean cohort. METHODS This cross-sectional study used a self-administered survey and was conducted in Argentina (2022). Patients with NMOSD were divided into three groups: private health insurance (PHI), social health insurance (SHI), and public health insurance (PHI, Ministry of Public Health). Differences in access and health care barriers were assessed. RESULTS One hundred patients with NMOSD (74 women) with a mean age at diagnosis of 38.7 years were included. Their EDSS was 2.8 and they were followed for 5.2 years. Of them, 51%, 11%, and 13% were employed (full-time: 57.5%), currently unemployed and retired by NMOSD, respectively. 55% of them visited between 2-3 specialists before NMOSD diagnosis. Aquaporin-4-antibody and/or myelin oligodendrocyte glycoprotein-antibody testing was requested in 91% (health insurance covered this partially in 15.3% and 32.9% of the time the test was entirely paid by patient/family). Patients with NMOSD receiving private medical care reported greater access to MRI, outpatient visits, and fewer issues to obtain NMOSD medications compared to those treated at public institutions. A longer mean time to MRI and neurology visit was found in the PHI group when compared with the other two subgroups. Regression analysis showed that private insurance (OR=3.84, p=0.01) was the only independent factor associated with appropriate access to NMOSD medications in Argentina. CONCLUSION These findings suggest that barriers to access and utilization of NMOSD care services in Argentina are common. NMOSD patients experienced problems to receive NMOSD medication properly, especially those from the public sector.
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Affiliation(s)
- Verónica Tkachuk
- Neuroimmunology Unit, Department of Neurology, Hospital de Clínicas, Buenos Aires, Argentina
| | | | - Ricardo Alonso
- Centro Universitario de Esclerosis Múltiple -CUEM, Hospital Ramos Mejía, Buenos Aires, Argentina
| | | | - Susana Del Valle Liwacki
- Neurology Unit, Hospital Córdoba, Córdoba, Argentina; Clínica Universitaria Reina Fabiola, Córdoba, Argentina
| | | | - Juan I Rojas
- Service of Neurology, Hospital Universitario de CEMIC, Buenos Aires, Argentina; Centro de Esclerosis Múltiple de Buenos Aires (CEMBA), Buenos Aires, Argentina
| | - Berenice Anabel Silva
- Centro Universitario de Esclerosis Múltiple -CUEM, Hospital Ramos Mejía, Buenos Aires, Argentina; Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - Gisela Zanga
- Neurology Unit, Hospital Cesar Milstein, Buenos Aires, Argentina
| | - Pablo López
- Department of Neurosciences, Neuroimmunology Unit, Hospital Alemán, Buenos Aires, Argentina
| | - Guillermo Delgado Garcia
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Centro de Investigación y Desarrollo en Ciencias de la Salud (CIDICS), Universidad Autónoma de Nuevo León, Monterrey, México
| | - Edgar Carnero Contentti
- Department of Neurosciences, Neuroimmunology Unit, Hospital Alemán, Buenos Aires, Argentina.
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Rojas JI, Patrucco L, Alonso R, Lopez PA, Deri N, Pettinicchi JP, Cristiano E, Carnero Contentti E. Preferences for Disease-Modifying Therapies in Argentina: Cross-Sectional Conjoint Analysis of Patients and Neurologist. Value Health Reg Issues 2022; 31:93-100. [DOI: 10.1016/j.vhri.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 03/11/2022] [Accepted: 04/03/2022] [Indexed: 10/18/2022]
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Henríquez K, Molt F, Gajardo J, Cortés B, Ramirez-Santana M. Sociodemographic and clinical characteristics of people with multiple sclerosis and neuro-myelitis optica spectrum disorder in a central northern region of Chile: A prevalence study. Mult Scler Relat Disord 2022; 61:103750. [DOI: 10.1016/j.msard.2022.103750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 02/28/2022] [Accepted: 03/18/2022] [Indexed: 10/18/2022]
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Espinoza MA, Rojas R, Zaupa A, Balmaceda C. A Model-Based Economic Evaluation of Cladribine Versus Alemtuzumab, Ocrelizumab and Natalizumab for the Treatment of Relapsing-Remitting Multiple Sclerosis with High Disease Activity in Chile. PHARMACOECONOMICS - OPEN 2021; 5:635-647. [PMID: 34224114 PMCID: PMC8611154 DOI: 10.1007/s41669-021-00282-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/09/2021] [Indexed: 06/13/2023]
Abstract
PURPOSE The aim of this study was to evaluate the cost effectiveness of cladribine compared with alemtuzumab, natalizumab, and ocrelizumab for the treatment of highly active multiple sclerosis (HAD-MS) from the perspective of the Chilean health care public sector. MATERIALS AND METHODS A Markov model was used to compare costs and quality-adjusted life-years (QALYs) over a 45-year time horizon using a 3% discount rate for costs and outcomes. Natural history of the disease was modeled in terms of progression of disability according to the Expanded Disability Status Scale (EDSS). A network meta-analysis was used as a source of comparative effectiveness for disability progression and annual relapse rates. Differences in costs and outcomes were modeled for only 10 years due to high temporal uncertainty. Ocrelizumab was assumed to have the same efficacy as cladribine due to lack of data. Direct costs were taken from national tariffs and expressed in 2019 US dollars. Utilities for EDSS health states were obtained from the literature. Second-order uncertainty was characterized through deterministic and probabilistic sensitivity analysis. FINDINGS Compared with natalizumab (the current strategy covered in Chile), cladribine is associated with incremental costs and QALYs of US$70,989 and 1.875, respectively (incremental cost-effectiveness ratio [ICER] $37,861). Ocrelizumab was extendedly dominated by cladribine and natalizumab, and alemtuzumab was dominated by cladribine. A scenario analysis of a 10% discount did not modify the results substantially, but showed a decrease in the ICER of cladribine versus natalizumab (ICER $29,833/QALY). IMPLICATIONS Cladribine is a new oral alternative to treat patients with HAD-MS that is expected to produce higher QALYs than all evaluated alternatives. In the context of a conservative analysis, cladribine cannot be considered cost effective for the Chilean health care public sector using a 1 GDP per capita threshold. However, under reasonable discount scenarios, cladribine becomes an attractive alternative for the health system.
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Affiliation(s)
- Manuel Antonio Espinoza
- Unidad de Evaluación de Tecnologías en Salud, Centro de Investigación Clínica, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, Piso 2, Santiago, Chile
- Departamento de Salud Pública, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, Piso 2, Santiago, Chile
| | | | - Alessandro Zaupa
- Departamento de Salud Pública, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, Piso 2, Santiago, Chile
| | - Carlos Balmaceda
- Unidad de Evaluación de Tecnologías en Salud, Centro de Investigación Clínica, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, Piso 2, Santiago, Chile.
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Cristiano E, Abad P, Becker J, Carrá A, Correale J, Flores J, Fruns M, Garcea O, Garcia Bónitto J, Gracia F, Hamuy F, Navas C, Patrucco L, Rivera V, Velazquez M, Rojas JI. Multiple sclerosis care units in Latin America: Consensus recommendations about its objectives and functioning implementation. J Neurol Sci 2021; 429:118072. [PMID: 34509134 DOI: 10.1016/j.jns.2021.118072] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/23/2021] [Accepted: 09/05/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Currently, there are several reasons to promote worldwide the concept of multiple sclerosis care units (MSCU) for a better management of affected patients. Ideally, the MSCU should have some human and technical resources that distinguish and improve the care of affected patients; however, local, and regional aspects should be considered when recommending how these units should operate. The objective of these consensus recommendations was to review how MSCU should work in Latin America to improve long-term outcomes in MS patients. METHODS A panel of neurology experts from Latin America dedicated to the diagnosis and care of MS patients gathered virtually during 2019 and 2020 to carry out a consensus recommendation about objectives and functioning implementation of MSCU in Latin America. To achieve consensus, the methodology of "formal consensus-RAND/UCLA method" was used. RESULTS Recommendations focused on the objectives, human and technical resources, and the general functioning that MSCU should have in Latin America. CONCLUSIONS The recommendations of these consensus guidelines attempt to optimize the health care and management of MS patients by setting how MSCU should work in our region.
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Affiliation(s)
- Edgardo Cristiano
- Centro de Esclerosis Múltiple de Buenos Aires, Buenos Aires, Argentina
| | - Patricio Abad
- Servicio Neurologia, Hospital Metropolitano de Quito, Ecuador, Profesor de Neurología PUCE, Ecuador
| | - Jefferson Becker
- Brain Institute of Rio Grande do Sul, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Adriana Carrá
- MS Section Hospital Britanico Buenos Aires, Argentina; Neurociencias Fundación Favaloro/INECO, Buenos Aires, Argentina
| | | | - José Flores
- Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, Mexico; Centro Neurológico ABC Santa Fé, Ciudad de México, Mexico
| | | | - Orlando Garcea
- Clínica de Esclerosis Múltiple, Hospital Ramos Mejía, Buenos Aires, Argentina
| | | | - Fernando Gracia
- Clinica de Esclerosis Multiple, Servicio de Neurologia Hospital Santo Tomas, Panama. Universidad Interamericana de Panama, Panama
| | - Fernando Hamuy
- Departamento de Neurologia, Hospital IMT, Paraguay; Departamento de Neurologia de Diagnóstico Codas Thompson, Paraguay
| | - Cárlos Navas
- Clinica Enfermedad Desmielinizante Clinica Universitaria Colombia, Colombia
| | - Liliana Patrucco
- Servicio de Neurología, Hospital Italiano de Buenos Aires, Argentina
| | | | | | - Juan Ignacio Rojas
- Centro de Esclerosis Múltiple de Buenos Aires, Buenos Aires, Argentina; Servicio de Neurología, Hospital Universitario de CEMIC, Buenos Aires, Argentina.
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Multiple sclerosis in Peru: National prevalence study using capture-recapture analysis. Mult Scler Relat Disord 2021; 55:103147. [PMID: 34332455 DOI: 10.1016/j.msard.2021.103147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 07/08/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND There is scarce epidemiological data on Multiple Sclerosis (MS) in Latin America. National epidemiological studies are needed to guide the health policy related to MS. OBJECTIVE To determine MS national prevalence in Peru and describe clinical and epidemiological characteristics of the disease. METHODS We conducted a cross-sectional prevalence study in Peru's four largest regions using two sources. We included adult patients diagnosed with MS by a neurologist using the McDonald criteria. We performed a capture-recapture analysis using the nearly unbiased estimator model, and calculated prevalence as the proportion of the adult Peruvian population in 2016. Additionally, we summarized patients epidemiological and clinical characteristics. RESULTS We identified 417 cases: 135 from the first source and 282 from the one. We found a point prevalence of 9.12 cases per 100 000 inhabitants (95% CI: 5.6 - 12.6). The age range was 35 to 45 years-old, and 51.9% were female. The most common type of MS was relapsing-remitting (79.3%) and the most frequent treatment was subcutaneous IFN-1b (40.7%). CONCLUSION Peru has a medium MS prevalence compared to other Latin American countries. Lima is the region with the highest number of cases, with similar clinical characteristics to other countries in the region.
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Rojas JI, Gracia F, Patrucco L, Alonso R, Carnero Contentti E, Cristiano E. Multiple sclerosis and neuromyelitis optica spectrum disorder testing and treatment availability in Latin America. Neurol Res 2021; 43:1081-1086. [PMID: 34240685 DOI: 10.1080/01616412.2021.1949686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND The objective of our study was to describe the availability of diagnostic tests and treatment for MS and NMOSD in Latin America (LATAM). METHODS A survey instrument was used in a sample of physicians from LATAM countries. The goal of the survey was to understand availability of: 1) imaging tests for diagnosing MS and NMOSD and its barriers; 2) diagnostic laboratory tests for diagnosing MS and NMOSD and its barriers; and 3) treatments for MS and NMOSD in the acute and chronic phases of the disease. RESULTS Responses were received from 80 physicians. AQP4-ab test was available in 54% of the countries and MOG-ab test in 42%. All of countries had available use of high doses of intravenous methylprednisolone, oral steroids, plasmapheresis, and intravenous immunoglobulins for relapses. For NMOSD, 93% of the countries were able to use azathioprine and mycophenolate mofetil, and 87% rituximab. In MS, 93% of countries had available to them IFN beta, 69% glatiramer acetate, 75% teriflunomide, 93% fingolimod, 69% dimethyl-fumarate, 75% cladribine, 69% natalizumab, 93% ocrelizumab and 81% alemtuzumab. The most common challenge and barrier identified was the cost of medications. CONCLUSION The present study allows an understanding of the delivery of care for MS and NMOSD in the region.
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Affiliation(s)
- Juan I Rojas
- Department of Neurology, Centro de esclerosis múltiple de Buenos Aires, Buenos Aires, Argentina.,Servicio de Neurología, Hospital Universitario de CEMIC, Buenos Aires, Argentina
| | - Fernando Gracia
- Clinica de Esclerosis Multiple, Servicio de Neurología, Hospital Santo Tomas, Panamá City, Panama.,Department of Neurology, Universidad Interamericana de Panama, Panama City, Panama
| | - Liliana Patrucco
- Servicio de Neurología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Ricardo Alonso
- Centro Universitario de Esclerosis Múltiple, Hospital Ramos Mejía, Buenos Aires, Argentina.,Servicio de Neurología, Hospital Universitario Sanatorio Guemes, Buenos Aires, Argentina
| | | | - Edgardo Cristiano
- Department of Neurology, Centro de esclerosis múltiple de Buenos Aires, Buenos Aires, Argentina
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Exchanging fluids The sociocultural implications of microbial, cultural, and ethnic admixture in Latin America. Politics Life Sci 2021; 39:56-86. [PMID: 32697057 DOI: 10.1017/pls.2020.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Knowledge of evolutionary influences on patterns of human mating, social interactions, and differential health is increasing, yet these insights have rarely been applied to historical analyses of human population dynamics. The genetic and evolutionary forces behind biases in interethnic mating and in the health of individuals of different ethnic groups in Latin America and the Caribbean since the European colonization of America are still largely ignored. We discuss how historical and contemporary sociocultural interactions and practices are strongly influenced by population-level evolutionary forces. Specifically, we discuss the historical implications of functional (de facto) polygyny, sex-biased admixture, and assortative mating in Latin America. We propose that these three evolutionary mechanisms influenced mating patterns, shaping the genetic and cultural landscape across Latin America and the Caribbean. Further, we discuss how genetic differences between the original populations that migrated at different times into Latin America contributed to their accommodation to and survival in the different local ecologies and interethnic interactions. Relevant medical and social implications follow from the genetic and cultural changes reviewed.
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Rojas JI, Carnero Contentti E, Abad P, Aguayo A, Alonso R, Bauer J, Becker J, Bustos AK, Carcamo CA, Carra A, Correa Diaz EP, Correale J, Cristiano E, Diaz AJ, Fernandez Liguori N, Flores J, Fruns M, Garcea O, Giachello SM, Godoy MD, Gracia F, Hamuy VF, Henestroza PR, Navarra JA, Navas C, Patrucco L, Perez Bruno M, Prato AS, Rivera VM, Rosa Martinez AR, Vanotti S, Vazquez M, Vizcarra D, Ysrraelit MC, Alonso Serena M. Research priorities in multiple sclerosis in Latin America: A multi-stakeholder call to action to improve patients care: Research priorities in MS in LATAM. Mult Scler Relat Disord 2021; 53:103038. [PMID: 34090128 DOI: 10.1016/j.msard.2021.103038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 05/13/2021] [Indexed: 11/26/2022]
Abstract
As human and economic resources are limited, especially in Latin America (LATAM), it is important to identify research priorities to improve multiple sclerosis (MS) patients care in the region. The objective was to generate a multidisciplinary consensus on research priorities in MS for patients care in LATAM by involving healthcare professionals and MS patient associations. METHODS: consensus was reached through a four-step modified Delphi method designed to identify and rate research priorities in MS in LATAM. The process consisted of two qualitative assessments, a general ranking phase and a consensus meeting followed by a more detailed ranking phase RESULTS: a total of 62 participants (35 neurologists, 4 nurses, 12 kinesiologists, 7 neuropsychologists and 4 patient association members) developed the process. At the final ranking stage following the consensus meeting, each participant provided their final rankings, and the top priority research questions were outlined. 11 research priorities were identified focusing on healthcare access, costs of the disease, physical and cognitive evaluation and rehabilitation, quality of life, symptoms management, prognostic factors, the need of MS care units and patient's management in emergencies like COVID-19. CONCLUSION: this work establishes MS research priorities in LATAM from multiple perspectives. To pursue the actions suggested could launch the drive to obtain information that will help us to better understand the disease in our region and, especially, to better care for affected patients.
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Affiliation(s)
- Juan I Rojas
- Centro de Esclerosis Múltiple de Buenos Aires, Argentina; Servicio de Neurología, Hospital Universitario CEMIC, Buenos Aires, Argentina.
| | - Edgar Carnero Contentti
- Neuroimmunology Unit, Department of Neuroscience, Hospital Alemán de Buenos Aires, Argentina
| | - Patricio Abad
- Servicio Neurologia, Hospital Metropolitano de Quito, Ecuador
| | - Adriana Aguayo
- Departamento de Neurociencias. Centro Universitario Ciencias de la Salud. Universidad de Guadalajara, México
| | - Ricardo Alonso
- Centro Universitario de Esclerosis Múltiple, Hospital Ramos Mejía, Buenos Aires, Argentina; Servicio de Neurología, Hospital Universitario Sanatorio Guemes, Buenos Aires, Argentina
| | - Johana Bauer
- EMA, esclerosis múltiple Argentina, Buenos Aires, Argentina
| | - Jefferson Becker
- Brain Institute of Rio Grande do Sul, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brasil
| | | | - Claudia A Carcamo
- Departamento de Neurologia, Pontificia Universidad Católica de Chile, Chile
| | - Adriana Carra
- MS Section. Hospital Britanico Buenos Aires, Argentina
| | | | - Jorge Correale
- Departamento de Neurologia, FLENI, Buenos Aires, Argentina
| | - Edgardo Cristiano
- Servicio de Neurología, Hospital Universitario CEMIC, Buenos Aires, Argentina
| | | | - Nora Fernandez Liguori
- Servicio de Neurología, Hospital Universitario Sanatorio Guemes, Buenos Aires, Argentina; Hospital Enrique Tornu, Buenos Aires, Argentina
| | - Jose Flores
- Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, México
| | | | - Orlando Garcea
- Servicio de Neurología, Hospital Universitario Sanatorio Guemes, Buenos Aires, Argentina
| | - Susana M Giachello
- ALCEM - Asociacion de Lucha contra la Esclerosis Multiple, Buenos Aires, Argentina
| | | | - Fernando Gracia
- Clinica de Esclerosis Multiple, Servicio de Neurologia Hospital Santo Tomas, Panama
| | | | - Paula R Henestroza
- ALCEM - Asociacion de Lucha contra la Esclerosis Multiple, Buenos Aires, Argentina
| | | | - Carlos Navas
- Clinica Enfermedad Desmielinizante Clinica Universitaria Colombia, Colombia
| | - Liliana Patrucco
- Servicio de Neurología, Hospital Italiano de Buenos Aires, Argentina; Unidad de Esclerosis Múltiple y enfermedades desmielinizantes, Hospital Italiano de Buenos Aires, Argentina
| | | | | | | | | | - Sandra Vanotti
- Centro Universitario de Esclerosis Múltiple, Hospital Ramos Mejía, Buenos Aires, Argentina
| | - Macarena Vazquez
- Departamento de Neurología, Escuela de Medicina Pontificia Universidad Católica de Chile, Chile
| | - Darwin Vizcarra
- Hypnos Instituto del Sueño, Clínica San Felipe, Universidad Peruana Cayetano Heredia, Lima, Peru
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Rumrill PD, Sánchez J, Wu JR, Rumrill S, Iwanaga K, Li J, Chan F. Differences in employment concerns between Hispanic and Caucasian persons with multiple sclerosis: A propensity score matching analysis. JOURNAL OF VOCATIONAL REHABILITATION 2021. [DOI: 10.3233/jvr-201115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Little is known about the experiences and concerns of Hispanic Americans with multiple sclerosis (MS), especially how their experiences and concerns compare to those of Caucasian Americans with MS. OBJECTIVE: The purpose of this study was to examine differences in satisfaction with the overall employment situation between two matched samples of adults with MS, namely, Hispanics and Caucasians. METHODS: Participants in this study responded to a national survey of the employment and community living concerns of people with MS. A propensity score matching (PSM) procedure was used to match participants based on demographic and MS-related variables. RESULTS: A two-sample Hotelling T2 test revealed no statistically significant between-group differences on satisfaction regarding fair treatment in the workplace but between-group differences were observed on satisfaction regarding legal rights and personal-environmental resources related to work. CONCLUSIONS: Implications for future research and clinical practice in rehabilitation counseling in the COVID-19 era are discussed.
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Affiliation(s)
| | | | - Jia-Rung Wu
- Northeastern Illinois University, Chicago, IL, USA
| | | | | | - Jian Li
- Kent State University, Kent, OH, USA
| | - Fong Chan
- University of Wisconsin-Madison, Madison, WI, USA
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Sá MJ, Soares Dos Reis R, Altintas A, Celius EG, Chien C, Comi G, Graus F, Hillert J, Hobart J, Khan G, Kissani N, Langdon D, Leite MI, Okuda DT, Palace J, Papais-Alvarenga RM, Mendes-Pinto I, Shi FD. State of the Art and Future Challenges in Multiple Sclerosis Research and Medical Management: An Insight into the 5th International Porto Congress of Multiple Sclerosis. Neurol Ther 2020; 9:281-300. [PMID: 32666470 PMCID: PMC7606370 DOI: 10.1007/s40120-020-00202-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Indexed: 02/07/2023] Open
Abstract
The 5th International Porto Congress of Multiple Sclerosis took place between the 14th and 16th of February 2019 in Porto, Portugal. Its intensive programme covered a wide-range of themes-including many of the hot topics, challenges, pitfalls and yet unmet needs in the field of multiple sclerosis (MS)-led by a number of well-acknowledged world experts. This meeting review summarizes the talks that took place during the congress, which focussed on issues in MS as diverse as the development and challenges of progressive MS, epidemiology, differential diagnosis, medical management, molecular research and imaging tools.
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Affiliation(s)
- María José Sá
- Department of Neurology, Centro Hospitalar Universitário de São João, Alameda Prof. Hernáni Monteiro, Porto, Portugal.
- Faculty of Health Sciences, University Fernando Pessoa, Rua Carlos da Maia, Porto, Portugal.
| | - Ricardo Soares Dos Reis
- Department of Neurology, Centro Hospitalar Universitário de São João, Alameda Prof. Hernáni Monteiro, Porto, Portugal.
- Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, Porto, Portugal.
| | - Ayse Altintas
- Department of Neurology, School of Medicine, Koç University, Istanbul, Turkey
| | - Elisabeth Gulowsen Celius
- Department of Neurology, Oslo University Hospital, Ullevål, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Claudia Chien
- NeuroCure Clinical Research Center, NeuroCure Cluster of Excellence, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Giancarlo Comi
- Department of Neurology, University Vita-Salute San Raffaele, Milan, Italy
| | - Francesc Graus
- Department of Neurology, August Pi i Sunyer Biomedical Research Institute (IDIBAPS) Hospital Clínic, Barcelona, Spain
| | - Jan Hillert
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Jeremy Hobart
- Department of Neurology, University Hospitals Plymouth, Plymouth, UK
- Peninsula Schools of Medicine and Dentistry, University of Plymouth, Plymouth, UK
| | - Gulfaraz Khan
- Department of Microbiology and Immunology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Najib Kissani
- Neurology Department, Marrakech University Hospital Mohammed VI, Marrakech, Morocco
- Neuroscience Research Laboratory, Marrakesh Medical School, Cadi Ayyad University, Marrakech, Morocco
| | - Dawn Langdon
- Department of Psychology, Royal Holloway, University of London, London, UK
| | - Maria Isabel Leite
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Darin T Okuda
- Department of Neurology and Neurotherapeutics, UT Southwestern Medical Center, Dallas, TX, USA
| | - Jacqueline Palace
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | | | | | - Fu-Dong Shi
- Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
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Rivera V, Gracia F, Díaz A. Therapeutic approaches to multiple sclerosis in Central America and the Caribbean during the COVID-19 pandemic. NEUROLOGÍA (ENGLISH EDITION) 2020. [PMID: 32893070 PMCID: PMC7543929 DOI: 10.1016/j.nrleng.2020.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Costa Arpín E, Naveiro Soneira J, Lema Bouzas M, González Quintela A, Prieto González JM. Epidemiology of multiple sclerosis in Santiago de Compostela (Spain). Acta Neurol Scand 2020; 142:267-274. [PMID: 32392359 DOI: 10.1111/ane.13265] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 04/30/2020] [Accepted: 05/05/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To analyze the frequency and demographic characteristics of multiple sclerosis (MS) in the Council of Santiago de Compostela (SPAIN). MATERIAL AND METHODS The patients diagnosed with MS according to the McDonald 2010 diagnostic criteria were identified within the population of the District of Santiago de Compostela. Several sources were used (records and databases from Hospital, General Practitioners, Private Clinics, and the MS Patients Association). Demographic and clinical data were obtained from the electronic files. RESULTS The incidence of MS between 2010 and 2015 was 8/100 000/year (95% CI: 6-10), and the prevalence on December 31, 2015, was 152/100 000 (95% CI: 127-176). The age-standardized prevalence (using the European Standard Population 2013) was 137 (95% CI: 114-159) and the incidence of 7 (95% CI: 2-12). The female:male ratio was 1.84, the mean age at the first symptom was 32.23 years, the diagnosis was delayed 3.12 years, and the mean EDSS was 2.82. 71.17% had relapsing-remitting MS, 16.55% secondary progressive MS, 7.59% primary progressive MS, and 0.69% progressive relapsing MS. A disease-modifying treatment was established in 62.76% of patients in a mean of 1.96 years after the diagnosis. CONCLUSIONS The northwest of Spain is a high-risk area for MS, with frequencies similar to other Atlantic regions and higher than the rest of the country.
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Affiliation(s)
- Eva Costa Arpín
- Neurology Department Hospital Clínico Universitario de Santiago de Compostela Santiago de Compostela Spain
| | - Javier Naveiro Soneira
- Neurology Department Hospital Clínico Universitario de Santiago de Compostela Santiago de Compostela Spain
| | - Manuela Lema Bouzas
- Neurology Department Hospital Clínico Universitario de Santiago de Compostela Santiago de Compostela Spain
| | - Arturo González Quintela
- Intern Medicine Department Hospital Clínico Universitario de Santiago de Compostela Santiago de Compostela Spain
| | - José María Prieto González
- Neurology Department Hospital Clínico Universitario de Santiago de Compostela Santiago de Compostela Spain
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16
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Clinical and demographic characteristics of primary progressive multiple sclerosis in Argentina: Argentinean registry cohort study (RelevarEM). Neurol Sci 2020; 41:3329-3335. [DOI: 10.1007/s10072-020-04680-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 08/07/2020] [Indexed: 12/26/2022]
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17
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Rojas JI, Alonso Serena M, Garcea O, Patrucco L, Carrá A, Correale J, Vrech C, Pappolla A, Miguez J, Doldan ML, Silveira F, Alonso R, Cohen L, Pita C, Silva BA, Fiol M, Gaitán MI, Marrodan M, Negrotto L, Ysrraelit MC, Deri N, Luetic G, Caride A, Carnero Contentti E, Lopez PA, Pettinicchi JP, Curbelo C, Martinez AD, Steinberg JD, Balbuena ME, Tkachuk V, Burgos M, Knorre E, Leguizamon F, Piedrabuena R, Liwacki SDV, Barboza AG, Nofal P, Volman G, Alvez Pinheiro A, Hryb J, Tavolini D, Blaya PA, Silva E, Blanche J, Tizio S, Caceres F, Saladino ML, Zanga G, Fracaro ME, Sgrilli G, Pagani Cassara F, Vazquez G, Sinay V, Menichini ML, Lazaro L, Cabrera LM, Bestoso S, Divi P, Jacobo M, Kohler E, Kohler M, Giunta D, Mainella C, Manzi R, Parada Marcilla M, Viglione JP, Martos I, Reich E, Jose G, Cristiano E, Fernández Liguori N. Multiple sclerosis and neuromyelitis optica spectrum disorders in Argentina: comparing baseline data from the Argentinean MS Registry (RelevarEM). Neurol Sci 2020; 41:1513-1519. [DOI: 10.1007/s10072-019-04230-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 12/24/2019] [Indexed: 12/27/2022]
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18
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Rivera V, Gracia F, Díaz A. [Therapeutic attitudes towards multiple sclerosis in Central America and the Caribbean facing the SARS-CoV-2 pandemia]. Neurologia 2020; 35:705-706. [PMID: 32893070 PMCID: PMC7386366 DOI: 10.1016/j.nrl.2020.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 07/09/2020] [Indexed: 01/05/2023] Open
Affiliation(s)
- V.M. Rivera
- Baylor College of Medicine, Houston, TX, Estados Unidos,Autor para correspondencia
| | - F. Gracia
- Universidad Interamericana de Panamá, Ciudad de Panamá, Panamá
| | - A. Díaz
- en representación de FOCEM-Foro Centroamericano y del Caribe de Esclerosis Múltiple, Instituto Guatemalteco del Seguro Social, Ciudad de Guatemala, Guatemala
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19
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Correa-Díaz EP, Ortiz MA, Toral AM, Guillen F, Terán E, Ontaneda D, García-Castillo M, Jácome-Sánchez C, Torres-Herrán G, Ortega-Heredia A, Buestán ME, Murillo-Calle J, Raza P, Baño G. Prevalence of multiple sclerosis in Cuenca, Ecuador. Mult Scler J Exp Transl Clin 2019; 5:2055217319884952. [PMID: 31695924 PMCID: PMC6822194 DOI: 10.1177/2055217319884952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 09/28/2019] [Accepted: 10/04/2019] [Indexed: 11/16/2022] Open
Abstract
Background Methods Results Conclusions
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Affiliation(s)
| | | | | | | | - Enrique Terán
- Colegio de Ciencias de la Salud, Universidad San Francisco de Quito
| | - Daniel Ontaneda
- Meller Center for Multiple Sclerosis, Neurological Institute, Cleveland Clinic
| | | | | | | | | | | | | | - Praneeta Raza
- Meller Center for Multiple Sclerosis, Neurological Institute, Cleveland Clinic
| | - Guillermo Baño
- Department of Neurology, Carlos Andrade Marín Hospital, Ecuador
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20
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An individual-based model for predicting the prevalence of depression. ECOLOGICAL COMPLEXITY 2019. [DOI: 10.1016/j.ecocom.2019.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Rivera VM. Multiple Sclerosis: A Global Concern with Multiple Challenges in an Era of Advanced Therapeutic Complex Molecules and Biological Medicines. Biomedicines 2018; 6:E112. [PMID: 30513578 PMCID: PMC6316848 DOI: 10.3390/biomedicines6040112] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 11/27/2018] [Accepted: 11/28/2018] [Indexed: 11/25/2022] Open
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.
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Affiliation(s)
- Victor M Rivera
- Department of Neurology, Baylor College of Medicine, Houston, TX 77030, USA.
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22
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Validation of CSF free light chain in diagnosis and prognosis of multiple sclerosis and clinically isolated syndrome: prospective cohort study in Buenos Aires. J Neurol 2018; 266:112-118. [PMID: 30386877 DOI: 10.1007/s00415-018-9106-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 10/26/2018] [Accepted: 10/27/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND The objective was to evaluate the precision of kappa and lambda free light chains (KFLC and LFLC) in CSF for the diagnosis of multiple sclerosis (MS) and prognosis of clinically isolated syndrome (CIS). METHODS CSF and serum samples from CIS, MS and other neurological non-MS disease were collected between 2015 and 2017. FLC concentrations were measured using immunoassay Freelite™. Results were correlated with the patients' diagnoses and ROC curve analysis was used to determine accuracy. In CIS patients, analysis of FLC were compared in CIS converters vs. non-converter during follow-up. RESULTS In the MS group (n = 41), the optimal cut-off for KFLC determined was 7 mg/L, with a diagnostic sensitivity and specificity of 95% and 97%, respectively. The optimal cut-off for LFLC was 0.7 mg/L, with a diagnostic sensitivity and specificity of 71% and 81%, respectively. 36 CIS patients were included; mean follow-up time was 28 ± 9 months, and 22 (61.1%) patients converted to MS. The median concentration of CSF K and LFLCs at CIS diagnosis was slightly higher in CIS-converters compared to non-converters, but this did not reach statistical significance (KFLC: median 7 ± 5.3 mg/L vs. 5 ± 2.3 mg/L, p = 0.11; LFLC 0.7 ± 0.33 mg/L vs. 0.5 ± 0.23 mg/L p = 0.16). A strong correlation was observed between the concentration of K and L FLCs at diagnosis and the change in PBVC during follow-up (r = 0.72 and r = 0.65, respectively). CONCLUSION KFLCs have a high sensitivity and specificity for the diagnosis of MS. FLC concentrations at CIS diagnosis were not significantly higher in CIS-converters.
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Consensus recommendations for the diagnosis and treatment of primary progressive multiple sclerosis in Latin America. J Neurol Sci 2018; 393:4-13. [DOI: 10.1016/j.jns.2018.07.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 07/26/2018] [Accepted: 07/30/2018] [Indexed: 11/21/2022]
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A systematic review about the epidemiology of primary progressive multiple sclerosis in Latin America and the Caribbean. Mult Scler Relat Disord 2018; 22:1-7. [DOI: 10.1016/j.msard.2018.02.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 02/20/2018] [Accepted: 02/22/2018] [Indexed: 01/06/2023]
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25
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Muñoz-Galindo IM, Moreno Calderón JA, Guarín Téllez NE, Arévalo Roa HO, Díaz Rojas JA. Health Care Cost for Multiple Sclerosis: The Case of a Health Insurer in Colombia. Value Health Reg Issues 2018; 17:14-20. [PMID: 29605798 DOI: 10.1016/j.vhri.2017.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 10/30/2017] [Accepted: 12/01/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND There have been many studies on the cost of multiple sclerosis in countries with high prevalence, whereas in Latin America such analyses are few. Taking into consideration the burden of this disease and the high financial impact of treatment on the health care system, it is necessary to know the behavior of cost of illness. OBJECTIVES To describe the direct costs associated with health care in patients with multiple sclerosis affiliated with a health insurer in Colombia. METHODS An analysis of direct costs of disease was performed from the perspective of the third-party payer. A direct measurement from the technical costing "top-down" approach was used. Data were adjusted for inflation and expressed in 2014 US dollars. RESULTS The average annual cost per patient for the country was $29,339 (2010), $20,956 (2011), $23,892 (2012), $24,148 (2013), and $22,688 (2014). Drug therapy represented 86.1% of the total cost. Between 2010 and 2013, interferons accounted for the largest proportion of the costs of drug treatment (98.5% to 53%), whereas fingolimod showed an increase and accounted for 47% in 2014. CONCLUSIONS Medications account for the largest proportion of disease costs, with few variations in the last 5 years; nevertheless, the increase in the use of new pharmaceuticals poses a challenge to maintain the financial balance of health insurance.
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Ontaneda D, Correale J. The challenges and opportunities of multiple sclerosis care in Latin America. Mult Scler J Exp Transl Clin 2017; 3:2055217317720845. [PMID: 28979792 PMCID: PMC5617094 DOI: 10.1177/2055217317720845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
| | - Jorge Correale
- Department of Neurology, Raúl Carrea Institute for Neurological Research, Argentina
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27
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Rivas Alonso V, Flores Rivera JDJ, Rito García Y, Corona T. The genetics of multiple sclerosis in Latin America. Mult Scler J Exp Transl Clin 2017; 3:2055217317727295. [PMID: 28979796 PMCID: PMC5617105 DOI: 10.1177/2055217317727295] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 07/25/2017] [Indexed: 12/14/2022] Open
Abstract
Background In today’s globalised world, the heterogeneity of diseases such as multiple sclerosis has been studied since it has been suggested that ethnic differences, in conjunction with geographical and environmental factors, influence its incidence and prevalence. Aim Based on this, an attempt has been made to identify the genetic factors that may confer risk or protection, not only for developing multiple sclerosis but also for determining the course of its evolution. Results In Latin America we have some data about this, which have been replicated in different populations in the entire region, with very different results compared with other regions, which could explain not only the different frequencies in some populations, such as Caucasians, but also the course of the disease and the response to actual treatments. However, in addition to these findings, other associated epigenetic mechanisms have also been found in our populations, such as levels of vitamin D, parasitic diseases, and indigenous populations. Therefore, the study of epigenetics plays a crucial role in understanding the physiopathology of multiple sclerosis. It must be studied in each population, especially in Latin America, due to its broad heterogeneity. Conclusion It is very important to understand not only the genetic and external factors with these very specific effects in multiple sclerosis patients, but also the way they interact and are able to explain the frequency and some specific phenotypes of the disease in our populations besides the posibility to be a very specific treatment target.
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Affiliation(s)
- Verónica Rivas Alonso
- Clinical Laboratory of Neurodegenerative Diseases, National Institute of Neurology and Neurosurgery "Dr Manuel Velasco Suárez", México
| | - José de Jesús Flores Rivera
- Clinical Laboratory of Neurodegenerative Diseases, National Institute of Neurology and Neurosurgery "Dr Manuel Velasco Suárez", México
| | - Yamel Rito García
- Clinical Laboratory of Neurodegenerative Diseases, National Institute of Neurology and Neurosurgery "Dr Manuel Velasco Suárez", México
| | - Teresa Corona
- Clinical Laboratory of Neurodegenerative Diseases, National Institute of Neurology and Neurosurgery "Dr Manuel Velasco Suárez", México
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Amezcua L. MS in self-identified Hispanic/Latino individuals living in the US. Mult Scler J Exp Transl Clin 2017; 3:2055217317725103. [PMID: 28979795 PMCID: PMC5617095 DOI: 10.1177/2055217317725103] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Accepted: 07/07/2017] [Indexed: 12/26/2022] Open
Abstract
Self-identified Hispanic/Latino individuals living with multiple sclerosis (MS) in the continental United States (US) are a diverse group that represents different cultural and ancestral backgrounds. A marked variability in the way MS affects various subgroups of Hispanics in the US has been observed. We reviewed and synthesized available data about MS in Hispanics in the US. There are likely a host of multifactorial elements contributing to these observations that could be explained by genetic, environmental, and social underpinnings. Barriers to adequate MS care in Hispanics are likely to include delivery of culturally competent care and social and economic disadvantages. Considerable efforts, including the formation of a national consortium known as the Alliance for Research in Hispanic Multiple Sclerosis (ARHMS), are underway to help further explore these various factors.
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Affiliation(s)
- Lilyana Amezcua
- Department of Neurology, University of Southern California, Keck School of Medicine, USA
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Correa E, Paredes V, Martínez B. Prevalence of multiple sclerosis in Latin America and its relationship with European migration. Mult Scler J Exp Transl Clin 2017; 2:2055217316666407. [PMID: 28607738 PMCID: PMC5433402 DOI: 10.1177/2055217316666407] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 08/04/2016] [Indexed: 12/03/2022] Open
Abstract
Multiple sclerosis (MS) is a chronic, degenerative autoimmune inflammatory disease of the central nervous system. The prevalence is different in every continent, changing according to geographical and environmental characteristics. The areas with the highest prevalence in the world are Europe and North America. In Latin America, the prevalence is higher in areas where there was greater European migration, as in the case of Argentina, Chile, Brazil, Uruguay and Mexico, and there have been no identified cases amongst native Indian populations. It should be considered that environmental factors may influence the prevalence of MS in Latin America, and it seems as if there are protective factors such as exposure to ultraviolet radiation and the presence of parasitosis.
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Affiliation(s)
| | | | - Braulio Martínez
- Department of Neurology and Autoimmune Diseases, Carlos Andrade Marin Hospital, Quito, Ecuador
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Abstract
Novel epidemiological data have appeared in recent years in Latin America (LATAM). The objective of this study was to perform an updated systematic review of the epidemiology of the disease reported in LATAM.
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Affiliation(s)
| | - Juan Ignacio Rojas
- Department of Neurology, MS Clinic, Hospital Italiano de Buenos Aires, Argentina
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Chinea A, Ríos-Bedoya CF, Rubi C, Vicente I, Estades ER, Hernandez-Silvestrini YG. Incidence of Multiple Sclerosis in Puerto Rico, 2014: A Population-Based Study. Neuroepidemiology 2017; 48:55-60. [PMID: 28334724 DOI: 10.1159/000468989] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 03/07/2017] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Multiple sclerosis (MS) affects millions of people worldwide. The estimates for MS incidence are difficult to obtain but are important for understanding MS etiology, developing prevention strategies, and service planning. This study is aimed at estimating the 2014 incidence of MS in Puerto Rico (PR). METHODS The PR MS Foundation's registry was used as the data source. Neurologists, specialty pharmacies, MRI centers, health insurance companies, and the PR Department of Health identified MS cases missed by the registry. MS patients were 18 years and older and met the 2010 revised McDonald criteria. Age-standardized MS incidence rates and their corresponding 95% CIs were computed. RESULTS A total of 144 new MS cases were diagnosed in 2014. The age-standardized MS incidence rate was 5.1/100,000 (95% CI 4.3-5.9). The incidence rate was 7.1/100,000 (95% CI 5.7-8.5) for females and 2.9/100,000 (95% CI 2.0-3.8) for males. MS cases were mostly females (72.9%) with a mean age of 41.0 years (±1.0). CONCLUSION According to the country estimates, PR has a higher MS incidence than other Caribbean and Latin American countries, but a lower incidence compared to countries at higher latitudes. Our findings provide insights into the MS etiology in the Hispanic population that require additional research.
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Affiliation(s)
- Angel Chinea
- San Juan Multiple Sclerosis Center, Guaynabo, Puerto Rico
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Rojas JI, Patrucco L, MIguez J, Sinay V, Cassara FP, Cáceres F, Liguori NF, Saladino ML, Deri N, Jaacks G, Marcilla MP, Arrigoni MI, Correale J, Fiol M, Ysrraelit MC, Carrá A, Curbelo MC, Martinez A, Steinberg J, Bestoso S, Hryb JP, Di Pace JL, Perassolo MB, Contentti EC, Caride A, Lopez PA, Martinez C, Reich E, Giunta D, Cristiano E. Gender ratio trends over time in multiple sclerosis patients from Argentina. J Clin Neurosci 2017; 38:84-86. [PMID: 28087187 DOI: 10.1016/j.jocn.2016.12.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 12/26/2016] [Indexed: 11/19/2022]
Abstract
Several studies in multiple sclerosis (MS) suggest a trend of increasing disease frequency in women during the last decades. A direct comparison of gender ratio trends among MS populations from Argentina remains to be carried out. The objective of the study was to compare gender ratio trends, over a 50-year span in MS populations from Argentina. METHODS multicenter study that included patients from 14 MS Centers of Argentina. Patients with definite MS with birth years ranging from 1940 to 1989 were included. Gender ratios were calculated by five decades based on year of birth and were adjusted for the F/M born-alive ratio derived from the Argentinean national registry of births. The F/M ratios were calculated using a multivariate logistic regression per five decades by the year of birth approach. Analyses were performed using Stata 10.1. RESULTS 1069 patients were included. Gender ratios showed a significant increase from the first to the last decade in the whole MS sample (from 1.8 to 2.7; p value for trend=0.023). The Gender ratio did not show differences considering MS subtype. CONCLUSION our study showed a modest increase of the F/M ratio (from 1.8 to 2.7) over time among patients affected by MS in Argentina.
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Affiliation(s)
- J I Rojas
- Centro de Esclerosis Múltiple de Buenos Aires, Hospital Italiano de Buenos Aires, Argentina.
| | - L Patrucco
- Centro de Esclerosis Múltiple de Buenos Aires, Hospital Italiano de Buenos Aires, Argentina
| | - J MIguez
- Centro de Esclerosis Múltiple de Buenos Aires, Hospital Italiano de Buenos Aires, Argentina
| | - V Sinay
- Instituto de Neurociencias Fundación Favaloro (INCyT), Argentina
| | - F Pagani Cassara
- Instituto de Neurociencias Fundación Favaloro (INCyT), Argentina
| | - F Cáceres
- Neurosciences Institute of Buenos Aires (INEBA), Buenos Aires, Argentina
| | | | - M L Saladino
- Neurosciences Institute of Buenos Aires (INEBA), Buenos Aires, Argentina
| | - N Deri
- Centro de Investigación DIABAID, Argentina
| | - G Jaacks
- Centro de Investigación DIABAID, Argentina
| | | | | | - J Correale
- Department of Neurology, Institute for Neurological Research Dr. Raúl Carrea, FLENI, Argentina
| | - M Fiol
- Department of Neurology, Institute for Neurological Research Dr. Raúl Carrea, FLENI, Argentina
| | - M C Ysrraelit
- Department of Neurology, Institute for Neurological Research Dr. Raúl Carrea, FLENI, Argentina
| | - A Carrá
- Hospital Británico Buenos Aires, Argentina
| | | | - A Martinez
- Hospital Británico Buenos Aires, Argentina
| | | | - S Bestoso
- Hospital Escuela "José F. De San Martín", Corrientes, Argentina
| | - J P Hryb
- Hospital General de Agudos Carlos G Durand, Buenos Aires, Argentina
| | - J L Di Pace
- Hospital General de Agudos Carlos G Durand, Buenos Aires, Argentina
| | - M B Perassolo
- Hospital General de Agudos Carlos G Durand, Buenos Aires, Argentina
| | | | - A Caride
- Hospital Alemán, Buenos Aires, Argentina
| | - P A Lopez
- Hospital Alemán, Buenos Aires, Argentina
| | | | - E Reich
- Hospital Julio Mendez, Buenos Aires, Argentina
| | - D Giunta
- Centro de Esclerosis Múltiple de Buenos Aires, Hospital Italiano de Buenos Aires, Argentina
| | - E Cristiano
- Centro de Esclerosis Múltiple de Buenos Aires, Hospital Italiano de Buenos Aires, Argentina
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Paz-Ballesteros WC, Monterrubio-Flores EA, de Jesús Flores-Rivera J, Corona-Vázquez T, Hernández-Girón C. Cigarette Smoking, Alcohol Consumption and Overweight in Multiple Sclerosis: Disability Progression. Arch Med Res 2017; 48:113-120. [DOI: 10.1016/j.arcmed.2017.03.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 02/02/2017] [Indexed: 01/07/2023]
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Caneda MAGD, Vecino MCAD. The correlation between EDSS and cognitive impairment in MS patients. Assessment of a Brazilian population using a BICAMS version. ARQUIVOS DE NEURO-PSIQUIATRIA 2016; 74:974-981. [PMID: 27991994 DOI: 10.1590/0004-282x20160151] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Accepted: 09/01/2016] [Indexed: 11/22/2022]
Abstract
Objectives To investigate the correlation between the disabilities of MS patients and their cognitive impairment assessed by the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS). Methods Forty patients with definitive diagnoses of MS were selected. The correlation coefficient (r) between the Expanded Disability Status Scale (EDSS) and the neuropsychological tests of BICAMS were calculated. Results The correlation was clinically substantial and significant with r = 0.55 (p < 0.01) in the Symbol Digit Modalities Test (SDMT), 0.54 (p < 0.01) in the Brief Visuospacial Memory Test (BVMT) and 0.40 (p < 0.05) in the California Verbal Learning Test (CVLT). Conclusion BICAMS has easy and satisfactory application and evaluation for routine visits and presents a significant correlation with the EDSS. Its use may be indicated for screening and monitoring of cognitive impairment in patients with MS.
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Affiliation(s)
- Marco A G de Caneda
- Hospital Moinhos de Vento, Instituto de Ensino e Pesquisa, Departamento de Neurologia, Grupo de Esclerose Múltipla, Porto Alegre RS, Brasil
| | - Maria Cecília A de Vecino
- Hospital Moinhos de Vento, Instituto de Ensino e Pesquisa, Departamento de Neurologia, Grupo de Esclerose Múltipla, Porto Alegre RS, Brasil
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Ribbons K, Lea R, Tiedeman C, Mackenzie L, Lechner-Scott J. Ongoing increase in incidence and prevalence of multiple sclerosis in Newcastle, Australia: A 50-year study. Mult Scler 2016; 23:1063-1071. [PMID: 27682228 DOI: 10.1177/1352458516671819] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Since 1959, multiple sclerosis (MS) prevalence has been estimated for the east coast Australian city of Newcastle. Previous surveys, conducted in 1988 and 2003, have described an increase in the prevalence and incidence of MS. OBJECTIVES In this study, we evaluated whether these trends continue and provide 50 years of MS epidemiological follow-up for this southern hemisphere city. METHODS Expressed per 100,000 people, prevalence of MS in Newcastle was calculated for those with a confirmed diagnosis of MS on 9 August 2011 and incidence based on the number of cases with MS diagnosis made during the preceding decade. Data were age-standardised to the total Australian population. Statistical comparisons were undertaken using Poisson regression analysis. RESULTS In 2011, the estimate of MS prevalence was 124.2, with female-to-male ratio reaching 3.1, a 53% increase in female predominance since 1996. MS incidence increased to 6.7, with a significantly higher proportion of new female cases since the previous survey. CONCLUSION Prevalence of MS in Newcastle has risen linearly and is contributed to by a substantial increase in new cases over the preceding decade. Female predominance of MS cases continues to increase with a new diagnosis three times more likely in women.
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Affiliation(s)
- Karen Ribbons
- Department of Neurology, John Hunter Hospital, New Lambton, NSW, Australia
| | - Rodney Lea
- Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Clare Tiedeman
- Department of Medicine, John Hunter Hospital, New Lambton, NSW, Australia
| | - Laura Mackenzie
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia
| | - Jeannette Lechner-Scott
- Department of Neurology, John Hunter Hospital, New Lambton, NSW, Australia/Hunter Medical Research Institute, Newcastle, NSW, Australia/School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia
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Cristiano E, Patrucco L, Miguez J, Giunta D, Correale J, Fiol M, Ysrraelit M, Cáceres F, Liguori NF, Saladino M, Garcea O, Silva B, Alonso R, Carrá A, Curbelo M, Martinez A, Steinberg J, Giachello S, Melcom M, Rojas J. Increasing prevalence of multiple sclerosis in Buenos Aires, Argentina. Mult Scler Relat Disord 2016; 9:91-4. [DOI: 10.1016/j.msard.2016.07.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 07/05/2016] [Accepted: 07/08/2016] [Indexed: 12/23/2022]
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Farez MF, Calandri IL, Correale J, Quintana FJ. Anti-inflammatory effects of melatonin in multiple sclerosis. Bioessays 2016; 38:1016-26. [DOI: 10.1002/bies.201600018] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Mauricio F. Farez
- Center for Research on Neuroimmunological Diseases (CIEN); Raúl Carrea Institute for Neurological Research (FLENI); Buenos Aires Argentina
- Department of Neurology; Raúl Carrea Institute for Neurological Research (FLENI); Buenos Aires Argentina
| | - Ismael L. Calandri
- Department of Neurology; Raúl Carrea Institute for Neurological Research (FLENI); Buenos Aires Argentina
| | - Jorge Correale
- Center for Research on Neuroimmunological Diseases (CIEN); Raúl Carrea Institute for Neurological Research (FLENI); Buenos Aires Argentina
- Department of Neurology; Raúl Carrea Institute for Neurological Research (FLENI); Buenos Aires Argentina
| | - Francisco J. Quintana
- Ann Romney Center for Neurologic Diseases, Brigham and Women's Hospital; Harvard Medical School; Boston MA USA
- The Broad Institute; Cambridge MA USA
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Rojas JI, Patrucco L, MIguez J, Sinay V, Cassara FP, Cáceres F, Liguori NF, Saladino ML, Deri N, Jaacks G, Marcilla MP, Arrigoni MI, Correale J, Fiol M, Ysrraelit MC, Carrá A, Curbelo MC, Martinez A, Steinberg J, Bestoso S, Hryb JP, Di Pace JL, Perassolo MB, Carnero Contentti E, Caride A, Lopez PA, Martinez C, Reich E, Cristiano E. Disease onset in familial and sporadic multiple sclerosis in Argentina. Mult Scler Relat Disord 2016; 6:54-56. [PMID: 27063623 DOI: 10.1016/j.msard.2016.01.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 12/28/2015] [Accepted: 01/19/2016] [Indexed: 10/22/2022]
Abstract
UNLABELLED The present study was carried out to assess if there is an anticipation of age at onset in younger generations of familial multiple sclerosis (FMS) vs. sporadic MS (SMS) in Argentina. METHODS multicenter study that included patients from 14 MS Centers of Argentina. Patients were considered as FMS if they had in their family at least one relative of first or second degree diagnosed with MS; otherwise, patients were considered to have SMS. We compared the age at onset between familial and sporadic cases as well as the age at onset between relatives from different generations in FMS vs. SMS. RESULTS 1333 patients were included, 97 of them were FMS (7.3%). A lower age at onset in the younger generations of FMS cases was found compared with older generations of FMS as well as. SMS cases (24.1±3.7 years vs. 30.3±5.7 years, and 32.4±9.4 respectively; p<0.001). No differences were observed between older generations of FMS vs. SMS cases (p=0.12). CONCLUSION we observed an anticipation of age at onset of MS in younger generations of patients with FMS vs. older generations of FMS and SMS.
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Affiliation(s)
- J I Rojas
- Centro de Esclerosis Múltiple de Buenos Aires, Hospital Italiano de Buenos Aires, Argentina.
| | - L Patrucco
- Centro de Esclerosis Múltiple de Buenos Aires, Hospital Italiano de Buenos Aires, Argentina
| | - J MIguez
- Centro de Esclerosis Múltiple de Buenos Aires, Hospital Italiano de Buenos Aires, Argentina
| | - V Sinay
- Instituto de Neurociencias, Fundación Favaloro, Argentina
| | | | - F Cáceres
- Neurosciences Institute of Buenos Aires (INEBA), Buenos Aires, Argentina
| | - N Fernandez Liguori
- Neurosciences Institute of Buenos Aires (INEBA), Buenos Aires, Argentina; Multiple Sclerosis Section Hospital E.Tornú, Buenos Aires, Argentina
| | - M L Saladino
- Neurosciences Institute of Buenos Aires (INEBA), Buenos Aires, Argentina; Multiple Sclerosis Section Hospital E.Tornú, Buenos Aires, Argentina
| | - N Deri
- Centro de Investigación DIABAID, Argentina
| | - G Jaacks
- Centro de Investigación DIABAID, Argentina
| | | | | | - J Correale
- Department of Neurology, Institute for Neurological Research Dr. Raúl Carrea, FLENI, Argentina
| | - M Fiol
- Department of Neurology, Institute for Neurological Research Dr. Raúl Carrea, FLENI, Argentina
| | - M C Ysrraelit
- Department of Neurology, Institute for Neurological Research Dr. Raúl Carrea, FLENI, Argentina
| | - A Carrá
- Hospital Británico Buenos Aires, Argentina
| | | | - A Martinez
- Hospital Británico Buenos Aires, Argentina
| | | | - S Bestoso
- Hospital Escuela "José F. De San Martín", Corrientes, Argentina
| | - J P Hryb
- Hospital General de Agudos Carlos G Durand, Buenos Aires, Argentina
| | - J L Di Pace
- Hospital General de Agudos Carlos G Durand, Buenos Aires, Argentina
| | - M B Perassolo
- Hospital General de Agudos Carlos G Durand, Buenos Aires, Argentina
| | | | - A Caride
- Hospital Alemán, Buenos Aires, Argentina
| | - P A Lopez
- Hospital Alemán, Buenos Aires, Argentina
| | - C Martinez
- Private Office, Private Office, Argentina
| | - E Reich
- Hospital Julio Mendez, Buenos Aires, Argentina
| | - E Cristiano
- Centro de Esclerosis Múltiple de Buenos Aires, Hospital Italiano de Buenos Aires, Argentina
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Flores J, Granados J, Alonso E, Rito Y, Ortega-Hernández E, Mena-Hernández L, Corona T. Presence of the HLADR13 allele among Mexican Mestizos suggests a protective factor against relapsing-remitting multiple sclerosis (RRMS). Clin Neurol Neurosurg 2015; 138:184-7. [DOI: 10.1016/j.clineuro.2015.08.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 07/22/2015] [Accepted: 08/18/2015] [Indexed: 11/27/2022]
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Negreiros AALVD, Sousa-Munõz RLD, Oliveira BESD, Nóbrega PVD, Monteiro LLD. Clinical and epidemiological profile of patients diagnosed with multiple sclerosis in João Pessoa, Paraíba, Brazil. ARQUIVOS DE NEURO-PSIQUIATRIA 2015; 73:741-5. [PMID: 26352490 DOI: 10.1590/0004-282x20150111] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Prevalence rates of multiple sclerosis (MS) suggest an interrelationship between genetic and environmental factors, ranging worldwide.Objectives Clinical and epidemiological characterization of MS patients in João Pessoa, Paraíba city.Methods Study involving patients treated in five services in the city.Results It included 87 patients with MS, representing a prevalence of 12.0 cases/100,000 population, mainly women (77%) and white people (66.7%) with mean age of 43 years and average age of the first outbreak of 32.2 years. Motor symptoms (65.5%) and relapsing-remitting clinical form (78.2%) predominated; the average of the Expanded Disability Status Scale (EDSS) scores was 3.5 and 72% used a type of immunomodulatory drug. There was a positive correlation between the number of outbreaks and the duration of the disease with EDSS scores.Conclusions The prevalence of the disease is considered average. The clinical and epidemiological characteristics are in line with most similar Brazilian studies.
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Rojas JI, Patrucco L, Trojano M, Lugaresi A, Izquierdo G, Butzkueven H, Jokubaitis V, Duquette P, Girard M, Grand'Maison F, Grammond P, Oreja-Guevara C, Hupperts R, Boz C, Petersen T, Bergamaschi R, Giuliani G, Lechner-Scott J, Barnett M, Rio ME, Van Pesch V, Amato MP, Iuliano G, Fiol M, Slee M, Verheul F, Fernandez-Bolanos R, Poehlau D, Saladino ML, Braber-Moerland LD, Deri N, Oleschko-Arruda W, Cabrera-Gomez JA, Paine M, Vella N, Kister I, Skromne E, Savino A, Shaw C, Moore F, Vucic S, Petkovska-Boskova T, Bacile EAB, Santiago V, Cristiano E. Multiple sclerosis in Latin America: A different disease course severity? A collaborative study from the MSBase Registry. Mult Scler J Exp Transl Clin 2015; 1:2055217315600193. [PMID: 28607702 PMCID: PMC5408755 DOI: 10.1177/2055217315600193] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 07/19/2015] [Indexed: 11/17/2022] Open
Abstract
Limited data suggest that multiple sclerosis (MS) in Latin America (LA) could be less severe than in the rest of the world. The objective was to compare the course of MS between LA and other regions.
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Affiliation(s)
| | | | - Maria Trojano
- Department of Basic Medical Sciences, Neuroscience, and Sense Organs, University of Bari, Italy
| | - Alessandra Lugaresi
- MS Center, Department of Neuroscience, Imaging, and Clinical Sciences, University G. d'Annunzio, Italy
| | | | | | - Vilija Jokubaitis
- Department of Neurology, Royal Melbourne Hospital, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia; Department of Neurology, Box Hill Hospital, Monash University, Australia
| | | | - Marc Girard
- Department of Neurology, Hôpital Notre Dame, Canada
| | | | | | | | | | - Cavit Boz
- Karadeniz Technical University, Turkey
| | | | | | | | - Jeannette Lechner-Scott
- Department of Medicine, John Hunter Hospital, Australia; Hunter Medical Research Institute, University of Newcastle, Australia
| | | | | | - Vincent Van Pesch
- Department of Neurology, Cliniques Universitaires Saint-Luc, Belgium
| | - Maria Pia Amato
- Department NEUROFARBA, Section of Neurosciences, University of Florence, Italy
| | | | | | - Mark Slee
- Flinders University and Medical Centre, Australia
| | - Freek Verheul
- Neurology Unit, Groen Hart Ziekenhuis, The Netherlands
| | | | | | | | | | | | | | | | | | | | - Ilya Kister
- New York University Langone Medical Center, USA
| | - Eli Skromne
- Hospital de Especialidades, Centro Medico Nacional Siglo XXI, Mexico
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Correale J, Flores J, Bonitto JG, Rodríguez CC, Oliveira EML. Use of Fingolimod in the Management of Relapsing-Remitting Multiple Sclerosis: Experience from Latin America. Adv Ther 2015; 32:612-25. [PMID: 26170106 PMCID: PMC4522024 DOI: 10.1007/s12325-015-0226-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Indexed: 11/24/2022]
Abstract
UNLABELLED Once-daily fingolimod 0.5 mg (FTY720; Gilenya(®), Novartis Pharma AG, Basel, Switzerland) is a sphingosine 1-phosphate receptor modulator that is approved for the treatment of relapsing multiple sclerosis (MS); currently, this includes approval in 13 Latin American countries. However, despite a well-characterized efficacy and safety profile in a large clinical development program, thus far there has been limited representation of patients from across the Latin American region. Differences in MS disease characteristics have been reported for the Latin American population compared with Caucasians, which may be additional to recent improvements in MS diagnosis. Furthermore, healthcare provision and regional socioeconomic factors exist that are unique to Latin America compared with other regions. Therefore, to optimize MS treatment pathways and improve patient clinical outcomes, it is important to investigate the efficacy and safety profile of fingolimod using ethnically relevant data. Here, we review key data from Hispanic patients enrolled in the fingolimod clinical trial program, summarize recent findings from the FIRST LATAM study, and appraise fingolimod data from real-world patient populations. FUNDING Novartis Pharma AG, Basel, Switzerland.
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Affiliation(s)
- Jorge Correale
- Department of Neurology, Institute for Neurological Research Raúl Carrea, FLENI, Buenos Aires, Argentina,
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Etemadifar M, Izadi S, Nikseresht A, Sharifian M, Sahraian MA, Nasr Z. Estimated Prevalence and Incidence of Multiple Sclerosis in Iran. Eur Neurol 2014; 72:370-4. [DOI: 10.1159/000365846] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Accepted: 07/09/2014] [Indexed: 11/19/2022]
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Melcon MO, Correale J, Melcon CM. Is it time for a new global classification of multiple sclerosis? J Neurol Sci 2014; 344:171-81. [PMID: 25062946 DOI: 10.1016/j.jns.2014.06.051] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 06/09/2014] [Accepted: 06/24/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND The geographic distribution of multiple sclerosis (MS) is classically divided into three zones based on frequency that were established by Kurtzke in the early 1970s. In recent years, an increasing number of epidemiological studies have shown significantly higher MS prevalence and incidence rates. OBJECTIVE The aim of this study was to review and update the geographic distribution of MS using incidence, prevalence and disease duration from the latest epidemiology surveys. METHODS We conducted a systematic review of articles on MS epidemiology published between January 1, 1990 and December 31, 2012. RESULTS MS studies were grouped by continent: the Americas, Europe, Asia, Australia/New Zealand, and Africa. A total of 101 studies were identified according to the inclusion criteria, and 58 reported incidence estimates. Globally, the median estimated incidence of MS was 5.2 (range: 0.5-20.6) per 100,000 p-yrs, the median estimated prevalence of MS was 112.0 (with a range of 5.2-335) per 100,000 p-yrs, and the average disease duration was 20.2 years (range: 7.6-36.2). CONCLUSION In the past few decades, the global prevalence and incidence patterns of MS have changed dramatically. Regardless of the reason of increasing prevalence and incidence rate, we suggest the need for a novel classification system based on global MS disease burden. Adopting such a system would improve economic efficiency and prioritization in health policy planning for MS.
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Affiliation(s)
- Mario O Melcon
- Foundation for Neuroepidemiology Research, Junín, Buenos Aires Province, Argentina.
| | - Jorge Correale
- Department of Neurology, Institute for Neurological Research Dr. Raúl Carrea, FLENI, Buenos Aires, Argentina
| | - Carlos M Melcon
- Foundation for Neuroepidemiology Research, Junín, Buenos Aires Province, Argentina
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Rojas JI, Patrucco L, Cristiano E. Current and emerging treatments for relapsing multiple sclerosis in Argentinian patients: a review. Degener Neurol Neuromuscul Dis 2014; 4:103-109. [PMID: 32669904 PMCID: PMC7337150 DOI: 10.2147/dnnd.s46557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 03/06/2014] [Indexed: 11/23/2022] Open
Abstract
Multiple sclerosis (MS) is an autoimmune disease of the central nervous system. Recent developments have led to newer therapeutic options for disease treatment. A few studies have reported MS prevalence rates between 12 and 20 per 100,000 inhabitants nationwide in Argentina, and an incidence of 1.76 cases per 100,000 inhabitants per year. Considering the epidemiology of MS in Argentina, the total number of patients affected is estimated at 5,000–8,000 patients, with nearly 55%–65% of patients having a relapsing-remitting MS subtype of the disease. The aim of this review is to provide an overview of current and emerging treatments available in Argentina for patients with MS.
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Affiliation(s)
- Juan I Rojas
- Multiple Sclerosis Center of Buenos Aires, Neurology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Liliana Patrucco
- Multiple Sclerosis Center of Buenos Aires, Neurology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Edgardo Cristiano
- Multiple Sclerosis Center of Buenos Aires, Neurology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Abstract
Before the advent of diagnostic criteria for multiple sclerosis (MS), it was reported that the prevalence of MS in Mexico was "one of the lowest in the world" (1.6/100,000).(1) The notion that MS was a rare neurologic disease among those living in the tropics of the Americas and Southern latitudes was widely accepted. The geopolitical boundaries of the region identified as Latin America (LA) extend from the southern border of United States with Mexico (32° North latitude) to the Argentinian and Chilean Patagonia in South America (56° South latitude). The largest Spanish-speaking island countries in the Caribbean-Cuba, Dominican Republic, and Puerto Rico-are also traditionally considered part of LA. The continental mass includes 17 countries with a population of more than 550 million. Due to centuries of racial intermixing, it is a heterogeneous and genetically complex population. The blended cultures of native Amerindians with white Caucasian Europeans and black Africans has resulted in the predominant ethnic Latin American Mestizo. The influence of African genetics is notable in many areas of the subcontinent and the Caribbean. A common observation across LA is the absence of identification of MS in non-mixed Amerindians(2); the reason for this phenomenon is unclear.
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Affiliation(s)
- Victor M Rivera
- From the Department of Neurology (V.M.R.), Baylor College of Medicine, Houston, TX; National Autonomous University of Honduras (M.T.M., R.M.D.), Tegucigalpa; and University of Guadalajara (M.A.M.), Mexico
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Management of relapsing–remitting multiple sclerosis in Latin America: Practical recommendations for treatment optimization. J Neurol Sci 2014; 339:196-206. [DOI: 10.1016/j.jns.2014.02.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 02/17/2014] [Indexed: 12/13/2022]
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Fiest K, Pringsheim T, Patten S, Svenson L, Jetté N. The Role of Systematic Reviews and Meta-Analyses of Incidence and Prevalence Studies in Neuroepidemiology. Neuroepidemiology 2014; 42:16-24. [DOI: 10.1159/000355533] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Castrop F, Haslinger B, Hemmer B, Buck D. Review of the pharmacoeconomics of early treatment of multiple sclerosis using interferon beta. Neuropsychiatr Dis Treat 2013; 9:1339-49. [PMID: 24072971 PMCID: PMC3783501 DOI: 10.2147/ndt.s33949] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Multiple sclerosis (MS) is a common neurological disease with increasing incidence and prevalence. Onset of disease is most frequently in young adulthood when productivity is usually highest; it is of chronic nature and, in the majority of patients, it will result in accumulation of disability. Due to loss of productivity in patients and caregivers as well as high expenses for medical treatment, MS is considered a disease with high economic burden for patients and society. Several drugs have been approved for treatment of MS. While treatment ameliorates the course of the disease, it is very costly; therefore, pharmacoeconomics, evaluating costs and effects of disease-modifying treatment in MS, has become an important issue. Here, we review the economic impact and treatment strategies of MS and discuss recent studies on pharmacoeconomics of early treatment with interferon beta.
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Affiliation(s)
- Florian Castrop
- Department of Neurology, Technische Universität München, Munich, Germany
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