مقاله انگلیسی رایگان در مورد دستورالعمل درمان تعدیل کننده بیماری ام اس – الزویر ۲۰۲۴

Abstract

The newly constituted National Multiple Sclerosis (MS) Society (NMSS)of the United Arab Emirates (UAE), set up a scientific committee to create a MS disease modifying treatment (DMT) guideline for UAE. The committee considered several unique features of the MS community in UAE including large number of expatriate population, wide variations in health insurance coverage, physician and patient preferences for DMT. The overall goal of the treatment guideline is to facilitate the most appropriate DMT to the widest number of patients. To this end it has adapted recommendations from various health systems and regulatory authorities into a pragmatic amalgamation of best practices from across the world. Importantly where data is unavailable or controversial, a common sense approach is taken rather than leave physicians and patients in limbo. The committee classifies MS into subcategories and suggests appropriate treatment choices. It recommends treatment of RIS and CIS with poor prognostic factors. It largely equates the efficacy and safety of DMT with similar mechanisms of action or drug classes e.g. ocrelizumab is similar to rituximab. It allows early switching of treatment for unambiguous disease activity and those with progression independent of relapses. Autologous hematopoietic stem cell transplantation can be offered to patients who fail one high efficacy DMT. Pragmatic guidance on switching and stopping DMT, DMT choices in pregnancy, lactation and pediatric MS have been included. It is expected that these guidelines will be updated periodically as new data becomes available.

Introduction

The United Arab Emirates (UAE) is home to about 10 million people, of which one million are Emirati citizens. UAE is considered a country with medium prevalence for Multiple Sclerosis (MS). Estimates of prevalence are crude and range from 57/100,000 increasing to 64/100,000 when age-standardised (Inshasi & Thakre, 2011, Schiess et al., 2016, Mohammed, 2016). MS is more common in native Emirati people than in a mixed population of Emiratis and expatriates with the majority having relapsing MS (Schiess et al., 2016).

All neurologists (not necessarily MS specialists) can manage MS. Primary care systems are not well established in UAE and patients self-refer to hospitals. Onward referrals to larger centres with expertise is uncommon, unless patients themselves chose to do so. Most MS Disease modifying treatments (DMT) are available in UAE. While UAE has a medical regulatory authority, its role has not yet extended into appraisals of individual medicines or cost effectiveness. Therefore, adoption of recommendations by the Food and Drug Administration(FDA) or European Medicines Agency (EMA) is the standard practice. There is presently no guideline for MS DMT in UAE. So, Neurologists use FDA, EMA approved drugs that are available in UAE as per their preferences and guided by the American Academy of Neurology (AAN), European Academy of Neurology (EAN) and Middle East North Africa Committee for Treatment and Research in MS (MENACTRIMS) guidelines (Yamout et al., 2024). This pragmatic approach combined with affordability (UAE per capita GDP is 44,315 USD compared to the EU 38,411 USD) (GDP comparision UAE and EU) has helped the quick introduction of new drugs in UAE once approved in North America or Europe.

Conclusions

MS is a complex chronic disease with high risk of long-term disability. In this broad and yet specific DMT guideline we have tried to put together pragmatic amalgamation of best practice from across the world that takes into account UAE’s unique situation and demography. The overall goal of the treatment guideline is to facilitate the most appropriate DMT to the widest number of patients and to facilitate emerging treatments earlier. Where data is unavailable or controversial, a common sense approach has been adopted rather than leave physicians and patients in limbo. It is expected that these guidelines will be updated periodically as new data becomes available.