Evaluation of diagnosis and treatment practices of Brazilian neurologists among patients with multiple sclerosis.

Cássia Elisa Marin,Ronaldo Maciel Dias,Antonio Pereira Gomes Neto,Claudia Cristina Ferreira Vasconcelos,Maria Fernanda Mendes,Alfredo Damasceno,Rafael Paternò Castello Dias-Carneiro,Mônica Koncke Fiuza Parolin,Jefferson Becker,Dagoberto Callegaro,Marcus Vinícius Magno Gonçalves,Oscar Fernández,Marco Aurélio Lana-Peixoto,Osvaldo Nascimento,José Artur Costa D’Almeida,Paulo Diniz Da Gama

doi:10.1590/0004-282x-anp-2020-0362

Abstract

Recent changes to the diagnostic criteria for multiple sclerosis (MS) and new medications have had a major impact on the way in which specialists manage the disease. To investigate factors considered by Brazilian neurologists in managing MS, and to identify how these contribute to diagnosis and treatment. Potential participants were selected by a steering committee (MS experts who developed this survey). Only MS specialists were included in the study (neurologists who had completed a neuroimmunology fellowship or who were treating more than 30 MS patients). Links to the online questionnaire were distributed between March 2019 and January 2020. This questionnaire was composed of sections with hypothetical MS scenarios. Neurologists from 13 Brazilian states responded to the survey (n = 94). In the clinically isolated syndrome (CIS) scenario, the respondents agreed to treat patients with a high risk of MS diagnosis, whereas in the radiologically isolated syndrome (RIS) half of the respondents opted not to treat, even among high-risk patients. In cases of low-activity relapsing-remitting MS (RRMS), the choice of treatment was distributed among interferon beta, glatiramer acetate and teriflunomide, which were changed to fingolimod and natalizumab, as RRMS severity increased. The topics in which disagreement was found included practices regarding use of disease-modifying therapy (DMT) for pregnant patients and the washout period required for some DMTs. This study enabled identification of areas of agreement and disagreement about MS treatment among Brazilian neurologists, which can be used to update future protocols and improve patient management.

Highlights

Multiple sclerosis (MS) is the most common inflammatory disease of the central nervous system (CNS), characterized by variable clinical and pathological manifestations[1,2]
The present study examined the diagnosis and treatment practices adopted by Brazilian neuroimmunology specialists, through application of a structured questionnaire presenting multiple multiple sclerosis (MS) patient scenarios
The number choosing to treat radiologically isolated syndrome (RIS) patients increased as other abnormalities appeared in complementary tests, such as spinal cord lesions or Gd+ lesions, or after a follow-up period, with the appearance of relapse symptoms

Summary

Introduction

Multiple sclerosis (MS) is the most common inflammatory disease of the central nervous system (CNS), characterized by variable clinical and pathological manifestations[1,2] It is responsible for a large personal and socioeconomic burden, since it affects people in an economically active age group[3]. The management of MS has changed rapidly over recent years, and new oral, intravenous and injectable medications for disease treatment have been approved[4,6]. These changes to MS therapy have had a major impact on the way in which medical specialists manage the disease. The topics in which disagreement was found included practices regarding use of disease-modifying therapy (DMT) for pregnant patients and the washout

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