Clinical Pathway for the Diagnosis and Management of Patients With Relapsing-Remitting Multiple Sclerosis: A First Proposal for the Peruvian Population.

César Caparó-Zamalloa,Andrely Huerta-Rosario,Carlos Alva-Díaz,Nicanor Mori,Victor Velásquez-Rimachi,Wenzel Ivan Dueñas-Pacheco,Roberto A Molina,Chandel Farroñay-García

doi:10.3389/fneur.2021.667398

Abstract

Background: Relapsing–remitting multiple sclerosis (RRMS) is a subtype of degenerative inflammatory demyelinating disease of multifactorial origin that affects the central nervous system and leads to multifocal neurological impairment.Objectives: To develop a clinical pathway (CP) for the management of Peruvian patients with RRMS.Methods: First, we performed a literature review using Medline, Embase, Cochrane, ProQuest, and Science direct. Then, we structured the information as an ordered and logical series of five topics in a defined timeline: (1) How should MS be diagnosed? (2) How should a relapse be treated? (3) How should a DMT be initiated? (4) How should each DMT be used? and (5) How should the patients be followed?Results: The personnel involved in the care of patients with RRMS can use a series of flowcharts and diagrams that summarize the topics in paper or electronic format.Conclusions: We propose the first CP for RRMS in Peru that shows the essential steps for diagnosing, treating, and monitoring RRMS patients based on an evidence-based medicine method and local expert opinions. This CP will allow directing relevant clinical actions to strengthen the multidisciplinary management of RRMS in Peru.

Highlights

Multiple sclerosis (MS) is a degenerative inflammatory demyelinating disease of multifactorial origin that affects the central nervous system (CNS) and leads to multifocal neurological impairment
We identified relevant evidence that covers issues related to the care of patients with RRMS, and during six meetings, we planned and designed five key topics developed in this Clinical pathways (CP): [1] diagnosis, [2] relapse treatment, [3] initiation of disease-modifying treatment (DMT), [4] use of each DMT, and [5] follow-up
The prognosis should be assessed according to the following unfavorable outcome factors: age >40 years, male sex, African American or Latin American ethnicity, polyfocal presentation, involvement of the afferent system, and partial or no recovery, all of which can increase the risk of developing aggressive forms of MS [19]

Summary

Introduction

Multiple sclerosis (MS) is a degenerative inflammatory demyelinating disease of multifactorial origin that affects the central nervous system (CNS) and leads to multifocal neurological impairment. It occurs more frequently in young adults aged between 15 and 35, being more frequent in women [1]. In South America, a prevalence of 5.24 cases per 100,000 inhabitants was recorded, in Panama and Argentina (Patagonia), with an estimated prevalence and incidence of 17.2/100,000 and 1.4/100,000, respectively [4, 5]. Relapsing–remitting multiple sclerosis (RRMS) is a subtype of degenerative inflammatory demyelinating disease of multifactorial origin that affects the central nervous system and leads to multifocal neurological impairment

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