Treatment of relapsing multiple sclerosis in Hungary – consensus recommendation from the Hungarian neuroimmunology society

Multiple sclerosis (MS) may impact quality of life, careers and family plans of the affected individuals. The current treatments with disease modifying therapies aim to prevent people with MS (pwMS) from disability accumulation and progression. Different countries have different reimbursement policies resulting in inequalities in patient care among geographical regions. Access to anti-CD20 therapies for relapsing MS is restricted in Hungary because therapy of individual cases only is reimbursed. In the light of the latest research and national guidelines, 17 Hungarian MS experts agreed on 8 recommendations regarding relapsing pwMS using the Delphi round method. Strong agreement (> 80%) was achieved in all except one recommendation after three rounds, which generated a fourth Delphi round. The experts agreed on treatment initiation, switch, follow-up and discontinuation, as well as on special issues such as pregnancy, lactation, elderly population, and vaccination. Well-defined national consensus protocols may facilitate dialogue between policymakers and healthcare professionals and thus contribute to better patient care in the long run

Prevalence of cognitive impairment among Hungarian patients with relapsing-remitting multiple sclerosis and clinically isolated syndrome

Background Cognitive impairment (CI) is a frequent symptom of multiple sclerosis (MS); its prevalence is reported to be 43–70%. It is one of the most important determinants of MS patients’ quality of life, as it is one of the main factors for MS patients becoming unemployed. Aim We aimed to determine the prevalence of CI among the relapsing-remitting MS (RRMS) and clinically isolated syndrome (CIS) patients in Hungary, to evaluate the predicting factors of CI and to assess the differences between sexes and patients with different educational levels. Patients and methods Five-hundred and fifty-three CIS and RRMS patients were enrolled to our study from three Hungarian MS centers. Age at screening, age at disease onset, disease duration, EDSS score, sex and educational levels were analyzed as socio-demographic factors. The BICAMS battery was used to assess their cognitive state, the BDI-II battery to assess depression. For statistical analysis, we utilized logistical regression, and used Fisher exact tests, chi-square tests and one-way ANOVA. Results The mean age of our patients was 44.93 ± 11.69 years, mean age at disease onset was 31.95 ± 10.01 years, the mean disease duration was 13.05 ± 8.05 years and the median EDSS score 2.0 (Range: 6.5, IQR:2.0) points. Three-hundred and sixteen (57.1%) patients had CI. Sex, educational level and EDSS score proved to be significant predictors of CI (OR: 2.71, p < 0.001; OR: 1.94, p = 0.023; OR: 0.47, p = 0.003 respectively). CI was significantly (p < 0.001) more frequent among men (70.1%) than women (52.0%). We found, that educational level and EDSS score were only a significant predicting factor among women. Thus, the prevalence of CI among women with college or university degree was significantly (p < 0.001) less common (39.4%) than women with 12–15 years of education (57.4%) and women without a high school degree (66.7%). Also, we found that among women with higher EDSS score than 2 points, the prevalence of CI is 69.9% as compared to women with EDSS score between 0 and 2 points, where the prevalence is 42.8% (p < 0.001). No such differences were observed among man. Discussion Our prevalence data is similar to those reported in the literature (43–70%), and almost identical to the one assessment using the BICAMS battery. We found that men are more vulnerable to CI than women in MS, as was reported recently. We are the first to report however, that higher educational level and lower EDSS scores are only associated with better cognitive performance in women. © 201

Compliance- és betegútvizsgálat betegségmódosító kezelés alatt álló sclerosis multiplexes betegeknél

Háttér és cél – Az epidemiológiai adatok és a kezelt betegek száma alapján felmerül, hogy a magyar sclerosis multiplexes (SM) betegek alacsonyabb számban, illetve kisebb arányban kapnak betegségmódosító kezelést (DMT), mint egyes környező országok SM- betegei. Ennek okát próbáltuk kideríteni. Módszerek – Először a betegek compli- ance-ét elemeztük a Nemzeti Egészség- biztosítási Alapkezelő (NEAK) anonimizált adatbázisa alapján. A NEAK vénybejelentési adatait 2014. július 1. és 2021. február 28. közötti időszakra vonatkozóan vizsgálva ösz- szesen 5441 beteg került be az elemzésbe. A vizsgálat másik részében az SM-betegek betegútjának kvantitatív és kvalitatív felméré- sét végeztük. Eredmények – A vizsgálatok szerint a magyar SM-betegek compliance-e a nem- zetközi SM-terápiás adatokhoz képest is jó, az egyéb neurológiai, illetve más, például cardiovascularis betegségekéhez képest pedig kiemelkedő. Nem mondható ez el a betegek megkérdezése alapján történt betegútelemzés eredményéről. A betegek jelezték, hogy gyakran nehezen férnek hozzá az állami egészségügyi ellátáshoz. Beteg- útjukat követve kiderült, hogy 3–5 orvosnál (háziorvos, különböző szakorvosok) kellett megjelenniük a diagnózis megszületéséig. Az SM-centrumokról viszont pozitív visszajelzést adtak. Bíznak a gondozó orvosaikban, em- patikusnak találják őket, amellett, hogy több időt igényelnének az életmódra vonatkozó kérdések megbeszélésére. Következtetés – Egyes környező országok- kal összehasonlítva Magyarországon alacso- nyabb a kezelt SM-betegek aránya, ami, mivel a betegek compliance-e megfelelő, a hazai betegútproblémára hívja fel a figyel- met. Az orvoskollégák továbbképzése az SM-specialista neurológusoknak is feladata. Ahogyan a stroke leggyakoribb tüneteit sike- rült bevezetni a közgondolkodásba, cél lehet ugyanez az SM-mel kapcsolatban is. | Background and purpose – Epidemiologi- cal data and the number of patients treated suggest that the proportion of Hungarian patients with Multiple Sclerosis (MS) receiv- ing disease-modifying therapy (DMT) is lower than in some neighboring countries. We in- vestigated possible reasons for this. Methods – First we analysed patient compli- ance based on an anonymised database of the National Health Insurance Fund (NHIF). A total of 5441 patients were included in the analysis from NHIF prescription data from 1 July 2014 to 28 February 2021. In the second part of the study, a quantitative and qualita- tive assessment of patient journeys of MS patients was conducted. Results – The compliance of Hungarian MS patients is good compared to interna- tional MS treatment data and outstanding compared to other neurological and other diseases, e.g. cardiovascular. This cannot be said about the results of the patient path- way analysis based on patient interviews. Patients indicated that they often have dif- ficulty accessing public health care. Tracing their pathways revealed that they needed to see 3-5 doctors (general practitioner, various specialists) before a diagnosis was made. However, they gave positive feedback about MS Centres. They trusted their doctors, found them empathetic, but they would have liked more time to discuss lifestyle issues. Conclusion – Compared to some neighbou- ring countries, Hungary has a lower propor- tion of patients with treated MS, which, given the good compliance of patients, highlights the problem of patient path in Hungary. Further training of fellow physicians is also a task for neurologists specialising in MS. Just as the most common symptoms of stroke have been successfully introduced into the public consciousness, the same can be the aim for MS

APOE epsilon status in Hungarian patients with primary progressive multiple sclerosis

PRINCIPLES: Apolipoprotein E (ApoE), an important glycoprotein in the transport, uptake and redistribution of cholesterol, is necessary in nerve tissue repair. The APOE gene (APOE) is involved in neurodegenerative diseases, the best-known association being that between the APOE epsilon4 allele and Alzheimer's disease. Multiple sclerosis (MS) is a chronic inflammatory neurological disease. The aim of this study was to assess (multicentre assessment) the possible influence of the APOE gene on the susceptibility of primary progressive MS (PPMS) in Hungary. METHODS: Polymerase chain reaction and restriction fragment length polymorphism were carried out on DNA isolated from 135 volunteers. RESULTS: The number of PPMS patients without the epsilon2 allele was found to be remarkably high, whilst the epsilon2 allele was overrepresented in the RRMS group. A markedly high frequency of the epsilon4 allele was found in the PPMS group and a very low frequency in the HC group. With regards to the clinical parameters, significant differences were observed between the RRMS and PPMS groups. Differences were also detected regarding the EDSS and MSSS scores when the patients were grouped by the presence or absence of the epsilon2 allele. All of the observed differences in the clinical parameters disappeared when the patients were further stratified by the type of MS. CONCLUSIONS: Our findings suggest that the presence of the epsilon2 and epsilon4 alleles may play a role in the development of the disease. However, if any type of the disease has already developed the alleles show no association with the clinical parameters

Factors influencing the health-related quality of life in Hungarian multiple sclerosis patients

Background: The 'Multiple Sclerosis Quality of Life Instrument' (MSQOL-54) was recently validated in Hungarian, on more than 400 multiple sclerosis (MS) patients. The aim of the present study was to examine the impact on their overall quality of life (QoL) of the demographic and clinical data on these patients, and their scores on different QoL scales. Methods: The Hungarian version of MSQOL-54 was given to patients at the outpatient units at the Department of Neurology, University of Szeged, and two other Hungarian MS centres. Additional data, including the EDSS scores of the patients, and relevant clinical and demographic data, were also collected. Results: The questionnaire scales relating to social function, general health, mental health and satisfaction with the sexual function mostly determined the overall QoL ratings. 62.1% of the patients indicated at least one comorbid condition. Depressed patients had a significantly worse quality of life (p<0.0001). Conclusions: MSQOL-54 is a useful tool for the recognition of possibly treatable factors influencing the QoL, but not assessed by the EDSS. Quality of life data have emerged on more than 400 patients, i.e. a considerable proportion of the Hungarian MS patient population. (C) 2010 Elsevier B.V. All rights reserved