There was high variability in reported sIBM prevalence estimates and the quality of the studies conducted. Existing evidence suggests an increase of prevalence estimates over time, which may be explained by growing disease awareness, improvements in diagnostic criteria and study methodologies. Further high quality studies are needed to understand if prevalence varies across geographies or ethnicities.

Background Secondary progressive multiple sclerosis (SPMS) is a subtype of multiple sclerosis (MS), which is a chronic neurological disease, characterised by inflammation of the central nervous system. Most of MS patients eventually progress to SPMS. This study estimates the prevalence of SPMS in the United States of America, Europe, Canada, Australia, and Brazil. Methods A systematic literature search of the Medline and Embase databases was performed using the OVID™ SP platform to identify MS epidemiological studies published in English from database inception to September 22, 2020. Studies reporting the prevalence of MS and proportion of SPMS patients in the included population were selected. The pooled prevalence of SPMS was calculated based on the proportion of SPMS patients. The Loney quality assessment checklist was used for quality grading. A meta-analysis of the proportions was conducted in RStudio. Results A total of 4754 articles were retrieved, and prevalence was calculated from 97 relevant studies. Overall, 86 medium- and high-quality studies were included in the meta-analysis. Most studies were conducted in European countries (84 studies). The estimated pooled prevalence of SPMS was 22.42 (99% confidence interval: 18.30, 26.95)/100,000. The prevalence of SPMS was more in the North European countries, highest in Sweden and lowest in Brazil. A decline in SPMS prevalence was observed since the availability of oral disease-modifying therapies. We also observed a regional variation of higher SPMS prevalence in urban areas compared with rural areas. Conclusion High variability was observed in the estimated SPMS prevalence, and the quality of the studies conducted. The influence of latitude and other factors known to affect overall MS prevalence did not fully explain the wide range of inter-country and intra-country variability identified in the results.

A547 intensity was, on average, moderate. The majority of respondents suffered pain in the head (e.g. headache and migraine) and back (e.g. lower back pain). Thirtyfour respondents (17.6%) were migraine sufferers. A third (37.3%) of respondents indicated that other family members also use CAM. The CAM classifications indicated for treating pain were cross-cultural (e.g. yoga), external (e.g. chiropractors, massage and heat therapy), internal (e.g. herbal supplements) and mind-body healing therapies (e.g. prayer therapy, sleep and meditation). The CAM modality reported to be most effective in treating pain was cross-cultural therapies with an average effectiveness of 3.6 out of a maximum score of 4.0. The most popular therapies were external body healing therapies (reported by 33.6% of respondents). Nearly half of the therapies were used in conjunction with conventional analgesics, with 43.0% indicating that they obtain their treatment for pain from pharmacies. ConClusions: CAM was used either on its own or in combination with conventional medication for the treatment of pain. Therapies seemed to be effective. The choice of CAM therapy was highly individualised.

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