Epidemiology of multiple sclerosis in Central Europe, update from Hungary

Abstract

Objectives Not so long ago, a novel phenotypic classification of multiple sclerosis (MS) and revisions to the McDonald diagnostic criteria were published. Good quality, standardized, and therefore comparable epidemiological data from the Central European region altogether are scarce, and data based on the aforementioned criteria are nonexistent; thus, an update is needed. Materials and Methods Patients residing in Csongrád county with a definitive diagnosis of MS according to the 2017 McDonald criteria were included and evaluated by the 2014 revised phenotypic classification. Results A total of 420 patients were included, of whom 313 were females (female/male ratio 2.925:1). Standardized prevalence was 101.8/100,000, and incidence was 4.44/100,000. Relapsing–remitting disease type was identified in 288 (68.57%) cases, of which 230 patients (79.86%) were treated and of which 202 patients (87.8%) showed no disease activity with their current treatment. Progressive disease type was seen in 132 (31.43%) cases, with 72 patients (54.54%) receiving treatment. More than half of the treated patients (178, 57%) were administered platform therapies, while 134 (43%) received highly active disease modifying therapies. Conclusion The prevalence of MS in Hungary similarly to other countries shows a constant increase in the past decades. The majority of our patients received treatment and had a stable disease while being treated. The distribution of disease courses, phenotypes, and treatment status fell in line with data in the literature based on MS registries with a large number of participants. Ours is the first study to give epidemiological data based on the most recent McDonald criteria and phenotypic classification from the Central European region.

Incidence and prevalence of multiple sclerosis in Hungary based on record linkage of nationwide multiple healthcare administrative data

“…Yearly drug dispension data. [16]. Other regional factors (number and availability of neurologists, ethnic and age distribution of population) can also play a role.…”

“…In this study we present our work on determining an administrative case definition of MS, followed by a two-step case-certification based on drug dispense records and a local cohort of patients. Given the lack of national MS patient registry, our main aim was to estimate the number of individuals living with MS in Hungary, as previously only regional data were published on epidemiology of MS [ 11 – 16 ]. In their most recent work, based on the patient register of one university MS-center, Biernacki et al [ 16 ] reported the standardized prevalence being 101.8/100,000 population (53.9 and 144.8/100.000 for men and women, respectively) in 2019.…”

“…Given the lack of national MS patient registry, our main aim was to estimate the number of individuals living with MS in Hungary, as previously only regional data were published on epidemiology of MS [ 11 – 16 ]. In their most recent work, based on the patient register of one university MS-center, Biernacki et al [ 16 ] reported the standardized prevalence being 101.8/100,000 population (53.9 and 144.8/100.000 for men and women, respectively) in 2019. Meanwhile, in MS Barometer 2015 [ 4 ] the Hungarian MS Society has reported that the estimated number of MS-patients countrywide was 8000, and in the review of Global Burden of MS [ 5 ] the number of subjects living with MS in Hungary is estimated to be between 5927 and 7480 in 2016, which both implicate a lower prevalence.…”

“…Our study reveals a significantly higher adjusted prevalence (119/100,000 in 2013 and 127.2/100,000 in 2015) than reported beforehand, showing a continuous rise between 2010 and 2015. The difference between the regional and administrative nationwide data could be the result of using different methods, for example that chronically disabled or bedridden patients may not visit regional university MS-center and thus are not registered there (recruitment bias), which is plausible regarding the rather low average EDSS score (2.8 points ±2.44) and high percentage of DMD-treated subjects (74.28%) [ 16 ]. Other regional factors (number and availability of neurologists, ethnic and age distribution of population) can also play a role.…”

“…As of today, only regional studies were conducted in Hungary on the epidemiology of MS [11][12][13][14][15][16], therefore the aim of our present study was to estimate the prevalence and incidence of patients living with MS in the whole country. Given the lack of a national MS-registry, we have used anonymized administrative data supplied by the National Health Insurance Fund (NHIF).…”