Treatment Issues in Multiple Sclerosis in Latin America Free

Treatment issues of multiple sclerosis (MS) in Latin America (LA) have recently been addressed [1,2]. Some particular features of the health systems, patients and medical providers are scarcely described. Moreover, LA patients are rarely included in clinical trials; therefore, data collected from key opinion leaders (KOL) from LA, although unofficial, remain as a needed source of information.

In a stand-alone gathering, organized by a pharmaceutical company, in Brazil 2014, according to ‘Compliance Program Guidance for Pharmaceutical Manufacturers' [3], we surveyed the opinion of KOL in MS from 6 LA countries. Neurologists were selected and invited to the gathering based on their academic, research and clinical experience with MS patients and involvement as participants and speakers on regional events.

A voluntary anonymous electronic survey was proposed in an interactive lecture (table 1). Important definitions were given previously without further discussion on the topic to avoid biased answers.

Early initiation of therapy and adherence in MS is of utmost importance. LA KOL report a fair amount of time during their patients' DMD initiation visit, which could be a good indicator of important therapy aspects being discussed with the patient and their families. KOL were adherent to LA guidelines about the scheduled frequency of patient's visits per year to the outpatient clinic [4]. On the other hand, most neurologists relied on self-report when evaluating adherence. Continuous support and follow-up by a dedicated trained staff have been related to better outcomes in MS. However, MS neurologists in our region are scarce and the situation regarding MS nurses might be even worse [5].

Only one third of KOL declared that over 80% of their patients kept the original treatment at the end of the first year. The main reason for treatment discontinuation was tolerability (injection stress, skin reactions, and injection pain), in contrast to global MS patients registered in the NARCOMS database, who discontinue treatment due to perceived lack of efficacy (no perceived benefit from the treatment, or worsening MS symptoms or disability) [6,7]. These results could also be explained by impaired availability of DMD, because of administrative issues and interchangeability among drugs.

Regarding LA Health Systems, we found a perceived improvement in treatment coverage. In 2011, experts estimated that below 35% of the LA population had access to DMDs [2]. In contrast, KOL now estimate greater proportions of their patients accessing these treatments. Nonetheless, KOL perceive that bureaucracy and corruption interfere with the availability of treatment.

Our survey showed LA KOL try to offer the best treatment to their patients, sometimes balancing costs, but they agree in never using immune-suppressors instead of DMDs in order to save money. Similarly, although biosimilars may represent a cheaper treatment option, LA KOL showed a remarkable uncertainty about their safety and efficacy that can explain the divided attitudes toward their use, which brings to spotlight the urgent need of clinical trials.

Fair access to DMD, issues related to adherence, health systems, the uncertainty about biosimilars, are some of the obstacles that are yet to be overcome in the treatment of patients with MS in LA.