Optimization and stratification of multiple sclerosis treatment in fast developing economic countries: a perspective from Qatar

Deleu, Dirk; Mesraoua, Boulenouar; Khider, Hisham El; Canibaño, Beatriz; Melikyan, Gayane; Hail, Hassan Al; Mhjob, Noha; Bhagat, Anjushri; Ibrahim, Faiza; Hanssens, Yolande

doi:10.1080/03007995.2016.1261818

Cited by 6 publications

(22 citation statements)

References 174 publications

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“…Interferons were the first DMT to be introduced in the management of RRMS in the early 1990s, and rapidly became the standard of care for RRMS following demonstration of reduced risk of relapses and reduced frequency of MRI lesions, and reductions in the accumulation of disability, as reviewed previously 3 . Indeed, the widespread exposure of people with RRMS to these agents may have contributed to a decline in the average severity of RRMS over time, as shown by a declining background relapse rate in randomized, controlled trials 15 .…”

Section: Efficacymentioning

confidence: 98%

“…The consensus guidance we published in 2017 included a review of individual treatments for RRMS that were available at that time: alemtuzumab, dimethyl fumarate, fingolimod, glatiramer acetate, interferons, mitoxantrone, natalizumab, ocrelizumab and teriflunomide 3 . Accordingly, only a brief account of the properties of these medications will be given here, based on published reviews and the European labelling for these agents, with discussion focussed on new information that has appeared since our earlier consensus publication.…”

Section: Purpose Of This Sectionmentioning

confidence: 99%

“…Thus, clinical practice in Qatar is well placed to benefit from the increase in the number of efficacious DMTs. Two years ago, an expert group from Qatar published its consensus recommendations on the management of RRMS in that country 3 . This article seeks to extend and update this earlier guidance.…”

Section: Introductionmentioning

confidence: 99%

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Management of relapsing–remitting multiple sclerosis in Qatar: an expert consensus

Deleu

Canibaño

Mesraoua

et al. 2019

Current Medical Research and Opinion

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Healthcare systems vary greatly between countries. International, evidence-based guidelines for the management of multiple sclerosis (MS) may need to be adapted for use in particular countries. Two years ago, the authors published a comprehensive consensus guideline for the management of MS in Qatar. Since that time, the availability of disease-modifying treatments for relapsing-remitting MS (RRMS), and our understanding of how to apply those treatments, has increased. The authors present an update to our guidance, focussing on the management of relapsing-remitting RRMS. In particular, the authors consider the optimal use of different DMTs in patients presenting with mild, medium or high disease activity.

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Section: Efficacymentioning

confidence: 98%

Section: Purpose Of This Sectionmentioning

confidence: 99%

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Management of relapsing–remitting multiple sclerosis in Qatar: an expert consensus

Deleu

Canibaño

Mesraoua

et al. 2019

Current Medical Research and Opinion

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“…The mechanism of action and adverse effect profile of the different DMTs have been the subject of previous publications 98,99 . In this section, the DMTs have been classified as injectable, oral and infusion DMDs.…”

Section: The Use Of Dmts Before During and After Pregnancymentioning

confidence: 99%

“…IFNb, GA or natalizumab should be considered depending on the level of disease activity. However as DMF treatment may be associated with a significant drop in absolute lymphocyte, CD4, and CD8 counts, treatment with natalizumab should not be initiated before meaningful lymphocyte reconstitution (!800/mL) occurs, which generally takes places 6-8 weeks after DMF discontinuation 98 .…”

Section: Dimethyl Fumaratementioning

confidence: 99%

Pregnancy-related issues in women with multiple sclerosis: an evidence-based review with practical recommendations

Canibaño

Deleu

Mesraoua

et al. 2020

Journal of Drug Assessment

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Objective: To review the current evidence regarding pregnancy-related issues in multiple sclerosis (MS) and to provide recommendations specific for each of them. Research design and methods: A systematic review was performed based on a comprehensive literature search. Results: MS has no effect on fertility, pregnancy or fetal outcomes, and pregnancies do not affect the long-term disease course and accumulation of disability. There is a potential risk for relapse after use of gonadotropin-releasing hormone agonists during assisted reproduction techniques. At short-term, pregnancy leads to a reduction of relapses during the third trimester, followed by an increased risk of relapses during the first three months postpartum. Pregnancies in MS are not per se high risk pregnancies, and MS does not influence the mode of delivery or anesthesia unless in the presence of significant disability. MRI is not contraindicated during pregnancy; however, gadolinium contrast media should be avoided whenever possible. It is safe to use pulse dose methylprednisolone infusions to manage acute disabling relapses during pregnancy and breastfeeding. However, its use during the first trimester of pregnancy is still controversial. Women with MS should be encouraged to breastfeed with a possible favorable effect of exclusive breastfeeding. Disease-modifying drugs can be classified according to their potential for pregnancy-associated risk and impact on fetal outcome. Interferon beta (IFNb) and glatiramer acetate (GA) may be continued until pregnancy is confirmed and, after consideration of the individual risk-benefit if continued, during pregnancy. The benefit of continuing natalizumab during the entire pregnancy may outweigh the risk of recurring disease activity, particularly in women with highly active MS. GA and IFNb are considered safe during breastfeeding. The use of natalizumab during pregnancy or lactation requires monitoring of the newborn. Conclusions: This review provides current evidence and recommendations for counseling and management of women with MS preconception, during pregnancy and postpartum.

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Interferon beta 1a (Rebif®) in relapsing remitting multiple sclerosis

Sánchez

Fé

Suarez

et al. 2021

Drug Development Research

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Multiple sclerosis (MS) is an autoimmune neurodegenerative disease that affects the central nervous system. It is the second cause of neurological disability in young adults. The exact cause of the disease remains unknown and there is no curative treatment. It is imperative to evaluate the efficacy of newest, biotechnological products modifying the disease. This study was designed to evaluate the use of interferon beta 1a (Rebif®) in patients with relapsing remitting MS treated at International Center for Neurological Restoration. Thirty‐one patients with relapsing remitting MS, between 10 and 65 years of age, four males and 27 females, were treated with Rebif® three times per week during 1 year. The safety of the treatment was evaluated based on the adverse events and the efficacy based on the disability scale score, the number of attacks and the number of lesions at magnetic resonance imaging (MRI). The public clinical trial is registered in Cuba (Number B‐10‐030‐L03). Adverse effects occurred in 75% of the cases, but they were mild. A significant reduction in the number of attacks, the disability scale score and the number of lesions at MRI were observed in patients with relapsing remitting MS treated with Rebif®. The use of interferon beta 1a showed safety and efficacy in the treatment of patients with relapsing remitting MS.

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Optimization and stratification of multiple sclerosis treatment in fast developing economic countries: a perspective from Qatar

Abstract: Recommendations and algorithms for the management of CIS and RRMS have been developed relevant to the healthcare system of this fast-developing economic country.

Cited by 6 publications

References 174 publications

Management of relapsing–remitting multiple sclerosis in Qatar: an expert consensus

Management of relapsing–remitting multiple sclerosis in Qatar: an expert consensus

Pregnancy-related issues in women with multiple sclerosis: an evidence-based review with practical recommendations

Interferon beta 1a (Rebif®) in relapsing remitting multiple sclerosis

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