Epidemiología de la Esclerosis Múltiple en el área sanitaria de Ferrol

Programa Oficial de Doutoramento en Ciencias Sociosanitarias. 512V01[Resumen] Introducción: La epidemiología de la Esclerosis Múltiple (EM) es motivo de múltiples estudios debido a la posible influencia de factores ambientales y genéticos en su desarrollo. Objetivo: Conocer la incidencia y prevalencia de la EM en el Área Sanitaria de Ferrol (ASF). Metodología: Estudio retrospectivo de los pacientes con EM de la Sección de Neurología del ASF, estableciéndose el día 31 de diciembre de 2015 como “fecha de prevalencia” y analizando la incidencia de la enfermedad durante 2001-2015. Asimismo, se estudian los pacientes según su edad, sexo, agregación familiar, tiempo de evolución y fenotipo clínico. Resultados: Se estudian 214 pacientes. La prevalencia es de 109 casos/100.000 habitantes. La incidencia media durante 2001-2015 es de 5,5 casos/100.000 habitantes/año. La relación mujer/hombre es de 2,5/1. La forma clínica predominante es la remitente recurrente (RR). La edad media de comienzo de la enfermedad es de 34,5 años. Hay un 6,6% de formas familiares. Conclusiones: La prevalencia de la EM en el ASF es de las más altas notificadas en España. La incidencia, aunque elevada, es similar a las de otros estudios españoles recientes. Las características clínicas son similares a las de la mayoría de los pacientes de los estudios españoles contemporáneos.[Resumo] Introdución: A epidemioloxía da Esclerose Múltiple (EM) é motivo de múltiples estudos debido á posible influencia de factores ambientais e xenéticos no seu desenvolvemento. Obxectivo: Coñecer a incidencia e prevalencia da EM na Área Sanitaria de Ferrol (ASF). Metodoloxía: Estudo retrospectivo dos pacientes con EM da Sección de Neuroloxía da ASF, establecéndose o día 31 de decembro de 2015 como “data de prevalencia” e analizando a incidencia da enfermidade durante o período 2001-2015. Así mesmo, estúdanse os pacientes segundo a súa idade, sexo, agregación familiar, tempo de evolución e fenotipo clínico. Resultados: Estúdanse 214 pacientes. A prevalencia é de 109 casos/100.000 habitantes. A incidencia anual media durante 2001-2015 é de 5,5 casos/100.000 habitantes/ano. A relación muller/home é de 2,5/1. A forma clínica predominante é a remitente recorrente (RR). A idade media de comezo da enfermidade é de 34,5 anos. Hai un 6,6% de formas familiares. Conclusións: A prevalencia da EM na ASF é das máis altas notificadas en España. A incidencia, aínda que elevada, é similar á doutros estudos españois recentes. As características clínicas son similares ás da maioría dos pacientes dos estudos españois contemporáneos[Abstract] Introduction: The epidemiology of Multiple Sclerosis has motivated many studies due to the possible influence of certain environmental and genetic factors in its development. Aim: To research the incidence and prevalence of MS in the Ferrol Healthcare Area (FHA). Methodology: A retrospective study of MS patients at the Neurology Department of the FHA. A “prevalence date” of 31 December 2015 was established and the incidence of the disease was analysed for the period 2001 - 2015. Likewise, the distribution of patients according to age, sex, familial occurrence, evolution time and clinical phenotype. Results: We studied 214 patients. The prevalence is 109 cases / 100,000 inhabitants. The average annual incidence for the period 2001 - 2015 is 5.5 cases / 100,000 inhabitants / year. The ratio of women to men is 2.5:1. The predominant clinical form is relapsing remitting (RR). The average age at onset of the disease is 34.5 years. There are 6.6% of familial forms. Conclusions: The prevalence of MS in FHA is among the highest that have been reported in Spain. Incidence, although high, is similar to that found in other recent Spanish studies. The clinical characteristics of patients are similar to those in most contemporary Spanish studies

SARS-CoV-2 Infection in Multiple Sclerosis: Results of the Spanish Neurology Society Registry

Esclerosis múltiple; Coronavirus SARS-CoV-2; COVID-19; 2019-nCoVEsclerosi múltiple; Coronavirus SARS-CoV-2; COVID-19; 2019-nCoVMultiple sclerosis; Coronavirus SARS-CoV-2; COVID-19; 2019-nCoVObjective To understand COVID-19 characteristics in people with multiple sclerosis (MS) and identify high-risk individuals due to their immunocompromised state resulting from the use of disease-modifying treatments. Methods Retrospective and multicenter registry in patients with MS with suspected or confirmed COVID-19 diagnosis and available disease course (mild = ambulatory; severe = hospitalization; and critical = intensive care unit/death). Cases were analyzed for associations between MS characteristics and COVID-19 course and for identifying risk factors for a fatal outcome. Results Of the 326 patients analyzed, 120 were cases confirmed by real-time PCR, 34 by a serologic test, and 205 were suspected. Sixty-nine patients (21.3%) developed severe infection, 10 (3%) critical, and 7 (2.1%) died. Ambulatory patients were higher in relapsing MS forms, treated with injectables and oral first-line agents, whereas more severe cases were observed in patients on pulsed immunosuppressors and critical cases among patients with no therapy. Severe and critical infections were more likely to affect older males with comorbidities, with progressive MS forms, a longer disease course, and higher disability. Fifteen of 33 patients treated with rituximab were hospitalized. Four deceased patients have progressive MS, 5 were not receiving MS therapy, and 2 were treated (natalizumab and rituximab). Multivariate analysis showed age (OR 1.09, 95% CI, 1.04–1.17) as the only independent risk factor for a fatal outcome. Conclusions This study has not demonstrated the presumed critical role of MS therapy in the course of COVID-19 but evidenced that people with MS with advanced age and disease, in progressive course, and those who are more disabled have a higher probability of severe and even fatal disease.This work was funded by the Spanish Society of Neurology for the writing, editorial assistance, statistical analysis and the Article Processing Charge. Other contributions related to financial support for writing, statistical analysis, and editorial assistance were supported by Biogen, Bristol-Myers Squibb, Merck, Roche, Sanofi, and Teva

Defining a standard set of health outcomes for patients with relapsing-remitting multiple sclerosis

Outcome measurement; Patient-centred care; Relapsing-remitting multiple sclerosisMedición de resultados; Atención centrada en el paciente; Esclerosis múltiple remitente-recurrenteMesura de resultats; Atenció centrada en el pacient; Esclerosi múltiple recurrent-remissióBackground Standardizing health outcomes is challenging in clinical management, but it also holds the potential for creating a healthcare system that is both more effective and efficient. The aim of the present study is to define a standardized set of health outcomes for managing Relapsing-Remitting Multiple Sclerosis (RRMS). Methods The project was led and coordinated by a multidisciplinary scientific committee (SC), which included a literature review, a patient-focused group, three nominal group meetings, and two SC meetings. Results 36 outcome variables were included in the standard set: 24 clinical (including weight, smoking habit, comorbidities, disability, mobility, diagnosis of secondary progressive multiple sclerosis, relapsed-related variables, radiological variables, cognitive status and disease-related symptoms), nine treatment-related (pharmacological and non-pharmacological information), and 3 related to the impact of RRMS on the patient's life (quality of life, pregnancy desire, work-related difficulties). In addition, experts also agreed to collect 10 case-mix variables that may affect but cannot be controlled as part of the management of the condition: 4 sociodemographic (age, sex, race, and employment status) and 6 clinical (height, date of diagnosis and first episode, serological status, early symptoms, and number of relapses pre-diagnosis). Conclusion The information provided through the present standard set of outcome variables can improve the management of RRMS and promote patient-centred quality care.This project was supported by Bristol Myers Squibb

SARS-CoV-2 Infection in Multiple Sclerosis

To understand COVID-19 characteristics in people with multiple sclerosis (MS) and identify high-risk individuals due to their immunocompromised state resulting from the use of disease-modifying treatments. Retrospective and multicenter registry in patients with MS with suspected or confirmed COVID-19 diagnosis and available disease course (mild = ambulatory; severe = hospitalization; and critical = intensive care unit/death). Cases were analyzed for associations between MS characteristics and COVID-19 course and for identifying risk factors for a fatal outcome. Of the 326 patients analyzed, 120 were cases confirmed by real-time PCR, 34 by a serologic test, and 205 were suspected. Sixty-nine patients (21.3%) developed severe infection, 10 (3%) critical, and 7 (2.1%) died. Ambulatory patients were higher in relapsing MS forms, treated with injectables and oral first-line agents, whereas more severe cases were observed in patients on pulsed immunosuppressors and critical cases among patients with no therapy. Severe and critical infections were more likely to affect older males with comorbidities, with progressive MS forms, a longer disease course, and higher disability. Fifteen of 33 patients treated with rituximab were hospitalized. Four deceased patients have progressive MS, 5 were not receiving MS therapy, and 2 were treated (natalizumab and rituximab). Multivariate analysis showed age (OR 1.09, 95% CI, 1.04-1.17) as the only independent risk factor for a fatal outcome. This study has not demonstrated the presumed critical role of MS therapy in the course of COVID-19 but evidenced that people with MS with advanced age and disease, in progressive course, and those who are more disabled have a higher probability of severe and even fatal diseas