Multiple sclerosis risk perception and acceptance for Brazilian patients

<div><p>ABSTRACT The perception of multiple sclerosis (MS) severity and risk associated with therapies might influence shared decision making in different countries. We investigated the perception of MS severity and factors associated with risk acceptance in Brazil in 96 patients with relapsing-remitting MS using a standardized questionnaire and compared this with two European cohorts. Multiple sclerosis was perceived as a very severe disease and the risk of developing progressive multifocal leukoencephalopathy due to natalizumab was seen as moderate to high. Seventy-six percent considered a risk of 1:1,000, or higher, an impediment for natalizumab use. Older age was the only variable associated with higher risk acceptance and our patients showed a more conservative profile than German and Spanish patients. Our patients perceived MS severity and progressive multifocal leukoencephalopathy risk similarly to elsewhere, but their willingness to take risks was more conservative. This should be considered when discussing therapeutic options and it might have an impact on guideline adaptations.</p></div

Information of ancestry informative markers (AIMs) set for ancestral populations, multiple sclerosis (MS) and neuromyelitis optica (NMO) patients.

<p>(A) The panel of 12 ancestry informative markers (AIMs) for Africans (green), Europeans (red) and Amerindians (blue) were sufficient for an adequate discrimination among ancestral populations. (B) Principal components analysis (PCA) for NMO [Southeastern: Ribeirão Preto (NMO-RP), São Paulo (NMO-SP) and Belo Horizonte (NMO-BH); Central:-Goiânia (NMO-GO), and Northeastern: (Recife-Pernambuco (NMO-PE)] and MS patients from Ribeirão Preto (MS-RP) and control individuals from Ribeirão Preto (CTRL-RP) together with ancestral populations [Africans (green), Europeans (red) and Amerindians (blue)], showing that they clustered closer to Europeans than to Africans and Amerindians.</p

AIMs frequencies observed in MS and NMO patients and healthy controls from Ribeirao Preto (RP), and in Africans (AFR), Europeans (EUR) and Amerindians (AMZ).

<p>Significant differences (δ > 0.30) between ancestral populations are underlined in the last columns. European, African and Amerindian ancestry contributions and respective R² values are shown at the bottom of the Table.</p>a<p>Ancestry informative marker *1 alleles with their reference sequence number from database of National Center for Biotechnological Information (dbSNP/NCBI).</p>b<p>Single nucleotide polymorphism (SNP), insertion/deletion (Indel), and <i>Alu</i> insertion (Alu) polymorphism / allele that characterizes the *1 allele.</p>c<p>Chromosomal location of each AIM.</p

African ancestry indexes (AAI) distribution for ancestral populations, multiple sclerosis (MS) and neuromyelitis optica (NMO) patients.

<p>Distribution of African ancestry Index (AAI) for Africans (AFR-green), Amerindians (AMZ-blue) and Europeans (EUR-red) in NMO patients from several Brazilian regions [Southeastern: Ribeirão Preto (NMO-RP), São Paulo (NMO-SP) and Belo Horizonte (NMO-BH); Central:-Goiânia (NMO-GO), and Northeastern: (Recife-Pernambuco (NMO-PE)]; in MS patients from Ribeirão Preto (MS-RP); and in healthy controls from Ribeirão Preto (CTRL-RP).</p

Demographic, clinical and laboratory findings of neuromyelitis optica (NMO) and multiple sclerosis (MS) Brazilian patients.

<p>Demographic, clinical and laboratory findings of neuromyelitis optica (NMO) and multiple sclerosis (MS) Brazilian patients.</p