Multiple sclerosis and neuromyelitis optica spectrum disorder testing and treatment availability in Latin America

The objective of our study was to describe the availability of diagnostic tests and treatment for MS and NMOSD in Latin America (LATAM). A survey instrument was used in a sample of physicians from LATAM countries. The goal of the survey was to understand availability of: 1) imaging tests for diagnosing MS and NMOSD and its barriers; 2) diagnostic laboratory tests for diagnosing MS and NMOSD and its barriers; and 3) treatments for MS and NMOSD in the acute and chronic phases of the disease. Responses were received from 80 physicians. AQP4-ab test was available in 54% of the countries and MOG-ab test in 42%. All of countries had available use of high doses of intravenous methylprednisolone, oral steroids, plasmapheresis, and intravenous immunoglobulins for relapses. For NMOSD, 93% of the countries were able to use azathioprine and mycophenolate mofetil, and 87% rituximab. In MS, 93% of countries had available to them IFN beta, 69% glatiramer acetate, 75% teriflunomide, 93% fingolimod, 69% dimethyl-fumarate, 75% cladribine, 69% natalizumab, 93% ocrelizumab and 81% alemtuzumab. The most common challenge and barrier identified was the cost of medications. The present study allows an understanding of the delivery of care for MS and NMOSD in the region.

本研究旨在阐明拉丁美洲（Latin America, LATAM）地区多发性硬化症（Multiple Sclerosis, MS）与视神经脊髓炎谱系疾病（Neuromyelitis Optica Spectrum Disorder, NMOSD）的诊断检测与治疗手段可及性现状。本研究采用调研问卷对拉丁美洲多国的医师群体开展抽样调查，调研目标为厘清三类项目的可及性及其阻碍因素：1）用于诊断MS与NMOSD的影像学检测；2）用于诊断MS与NMOSD的实验室检测；3）MS与NMOSD急性期及慢性期的治疗方案。本次调研共回收80份医师有效问卷。54%的受访国家可开展水通道蛋白4抗体（Aquaporin 4 antibody, AQP4-ab）检测，42%的国家可开展髓鞘少突胶质细胞糖蛋白抗体（Myelin Oligodendrocyte Glycoprotein antibody, MOG-ab）检测。所有受访国家均可为疾病复发患者提供大剂量静脉注射甲泼尼龙、口服糖皮质激素、血浆置换以及静脉注射免疫球蛋白治疗。针对NMOSD，93%的受访国家可使用硫唑嘌呤（azathioprine）与吗替麦考酚酯（mycophenolate mofetil），87%的国家可使用利妥昔单抗（rituximab）。针对MS，93%的受访国家可提供干扰素β（Interferon beta, IFN-β）治疗，69%的国家可提供醋酸格拉替雷（glatiramer acetate），75%的国家可提供特立氟胺（teriflunomide），93%的国家可提供芬戈莫德（fingolimod），69%的国家可提供富马酸二甲酯（dimethyl-fumarate），75%的国家可提供克拉屈滨（cladribine），69%的国家可提供那他珠单抗（natalizumab），93%的国家可提供奥瑞珠单抗（ocrelizumab），81%的国家可提供阿仑单抗（alemtuzumab）。本次调研识别出的最普遍挑战与阻碍因素为药物治疗成本高昂。本研究有助于增进对拉丁美洲地区MS与NMOSD诊疗服务供给现状的认知。