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

ABSTRACT Background: 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. Objective: To investigate factors considered by Brazilian neurologists in managing MS, and to identify how these contribute to diagnosis and treatment. Methods: 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. Results: 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. Conclusions: 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.

摘要 背景：多发性硬化症（multiple sclerosis, MS）诊断标准的最新修订及新型药物的问世，对专科医师的疾病诊疗模式产生了重大影响。目的：本研究旨在调查巴西神经科医师在管理MS患者时考量的相关因素，并明确这些因素对疾病诊断与治疗的贡献。方法：本研究的指导委员会由开展本次调研的MS专家组成，负责遴选潜在受试者。本研究仅纳入MS专科医师，即完成神经免疫学专科进修或每年接诊超过30例MS患者的神经科医师。在线调查问卷链接于2019年3月至2020年1月期间发放。该问卷包含多个MS假想诊疗场景模块。结果：共有来自巴西13个州的神经科医师参与本次调研（n=94）。在临床孤立综合征（clinically isolated syndrome, CIS）场景中，受访者均同意对具有高MS诊断风险的患者开展治疗；而在放射学孤立综合征（radiologically isolated syndrome, RIS）场景中，即便针对高风险患者，仍有半数受访者选择不予治疗。对于低活动度复发缓解型多发性硬化症（relapsing-remitting multiple sclerosis, RRMS）患者，医师的初始治疗选择分布于干扰素β、醋酸格拉替雷与特立氟胺；随着RRMS病情严重程度升高，治疗方案会调整为芬戈莫德与那他珠单抗。本研究发现存在诊疗意见分歧的议题包括：妊娠患者的疾病修正治疗（disease-modifying therapy, DMT）使用规范，以及部分DMT所需的洗脱期。结论：本研究明确了巴西神经科医师在MS诊疗领域的共识与分歧点，相关结果可用于更新未来的诊疗指南，优化患者管理方案。