Evaluation of diagnosis and treatment practices of Brazilian neurologists among patients with multiple sclerosis

Cássia Elisa Marin; Dagoberto Callegaro; Marco Aurélio Lana-Peixoto; Oscar Fernández; Antonio Pereira Gomes Neto; Claudia Cristina Ferreira Vasconcelos; José Artur Costa d’Almeida; Marcus Vinícius Magno Gonçalves; Maria Fernanda Mendes; Mônica Koncke Fiuza Parolin; Osvaldo Nascimento; Paulo Diniz da Gama; Rafael PaternÒ Castello Dias-Carneiro; Ronaldo Maciel Dias; Alfredo Damasceno; Jefferson Becker; on behalf of the Brazilian Committee for Treatment and Research in Multiple Sclerosis (BCTRIMS)

doi:10.1590/0004-282X-ANP-2020-0362

Arquivos de Neuro-Psiquiatria, Table of Contents

CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2021; 79(07): 598-606
DOI: 10.1590/0004-282X-ANP-2020-0362

Article

Evaluation of diagnosis and treatment practices of Brazilian neurologists among patients with multiple sclerosis

Avaliação das práticas de diagnóstico e tratamento de pacientes com esclerose múltipla por neurologistas brasileiros

Cássia Elisa Marin

¹Pontifícia Universidade Católica do Rio Grande do Sul, Hospital São Lucas, Porto Alegre RS, Brazil.

,

Dagoberto Callegaro

²Universidade de São Paulo, Faculdade de Medicina de São Paulo, Hospital das Clínicas, São Paulo SP, Brazil.

,

Marco Aurélio Lana-Peixoto

³Universidade Federal de Minas Gerais, Faculdade de Medicina de Minas Gerais Hospital das Clínicas, Belo Horizonte MG, Brazil.

,

Oscar Fernández

⁴University of Malaga, Hospital Universitário Regional de Málaga, Malaga, Spain.

,

Antonio Pereira Gomes Neto

⁵Santa Casa de Belo Horizonte, Belo Horizonte MG, Brazil.

,

Claudia Cristina Ferreira Vasconcelos

⁶Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro RJ, Brazil.

,

José Artur Costa d’Almeida

⁷Hospital Geral de Fortaleza, Fortaleza CE, Brazil.

,

Marcus Vinícius Magno Gonçalves

⁸Universidade da Região de Joinville, Joinville SC, Brazil.

,

Maria Fernanda Mendes

⁹Santa Casa de São Paulo, Faculdade de Ciências Médicas, São Paulo SP, Brazil.

,

Mônica Koncke Fiuza Parolin

¹⁰Clínica Gonçalves Dias, Curitiba PR, Brazil.

,

Osvaldo Nascimento

¹¹Universidade Federal Fluminense, Rio de Janeiro RJ, Brazil.

,

Paulo Diniz da Gama

¹²Pontifícia Universidade Católica de São Paulo, São Paulo SP, Brazil.

,

Rafael PaternÒ Castello Dias-Carneiro

⁹Santa Casa de São Paulo, Faculdade de Ciências Médicas, São Paulo SP, Brazil.

,

Ronaldo Maciel Dias

¹³Hospital de Base do Distrito Federal, Brasília DF, Brazil.

,

Alfredo Damasceno

¹⁴Universidade Estadual de Campinas, Campinas SP, Brazil.

,

Jefferson Becker

¹Pontifícia Universidade Católica do Rio Grande do Sul, Hospital São Lucas, Porto Alegre RS, Brazil.

¹¹Universidade Federal Fluminense, Rio de Janeiro RJ, Brazil.

,

on behalf of the Brazilian Committee for Treatment and Research in Multiple Sclerosis (BCTRIMS)

› Author Affiliations

Abstract

ABSTRACT

Background: Recent changes to the diagnostic criteria for multiple sclerosis (MS) and new medications have had a major impact on the way in which specialists manage the disease. Objective: To investigate factors considered by Brazilian neurologists in managing MS, and to identify how these contribute to diagnosis and treatment. Methods: Potential participants were selected by a steering committee (MS experts who developed this survey). Only MS specialists were included in the study (neurologists who had completed a neuroimmunology fellowship or who were treating more than 30 MS patients). Links to the online questionnaire were distributed between March 2019 and January 2020. This questionnaire was composed of sections with hypothetical MS scenarios. Results: Neurologists from 13 Brazilian states responded to the survey (n = 94). In the clinically isolated syndrome (CIS) scenario, the respondents agreed to treat patients with a high risk of MS diagnosis, whereas in the radiologically isolated syndrome (RIS) half of the respondents opted not to treat, even among high-risk patients. In cases of low-activity relapsing-remitting MS (RRMS), the choice of treatment was distributed among interferon beta, glatiramer acetate and teriflunomide, which were changed to fingolimod and natalizumab, as RRMS severity increased. The topics in which disagreement was found included practices regarding use of disease-modifying therapy (DMT) for pregnant patients and the washout period required for some DMTs. Conclusions: This study enabled identification of areas of agreement and disagreement about MS treatment among Brazilian neurologists, which can be used to update future protocols and improve patient management.

RESUMO

Introdução: Mudanças recentes dos critérios diagnósticos e nos tratamentos para Esclerose Múltipla (EM) promoveram um grande impacto na maneira com que os especialistas manejam a doença. Objetivos: Investigar fatores considerados no manejo de pacientes com EM, por neurologistas brasileiros, bem como identificar como estes contribuem para o diagnóstico e o tratamento da doença. Métodos: Participantes foram selecionados pelo Comitê Organizador (especialistas em EM responsáveis por desenvolver a pesquisa). Apenas especialistas em EM foram incluídos (neurologistas com fellowship em neuroimunologia ou que atendem, atualmente, mais de 30 pacientes com EM). Os links de acesso a um questionário foram distribuídos entre março de 2019 e janeiro de 2020, o qual consistia em cenários hipotéticos referentes à EM. Resultados: Neurologistas de 13 estados brasileiros responderam à pesquisa (n=94). No cenário de Síndrome Clínica Isolada, os participantes concordaram em tratar pacientes com alto risco de diagnóstico de EM no futuro, resultado não encontrado nos casos de Síndrome Radiológica Isolada, no qual metade dos participantes optaram por não tratar, mesmo em casos de alto risco. Nos casos de EM Remitente-Recorrente de baixa atividade, a escolha para tratamento foi interferon beta, acetato de glatirâmer ou teriflunomida, sendo trocado para fingolimode e natalizumabe quando de aumento da gravidade. Discordâncias foram encontradas referentes ao uso de medicações durante a gestação e seus períodos de washout. Conclusões: Este estudo identificou concordâncias e discordâncias entre neurologistas brasileiros sobre EM, as quais podem ser auxiliares nas futuras atualizações de protocolos, visando melhorar o manejo dos pacientes.

Keywords:

Multiple Sclerosis - Neurologists - Diagnosis - Clinical Decision-Making - Immunotherapy

Palavras-chave:

Esclerose Múltipla - Neurologistas - Diagnóstico - Tomada de Decisão Clínica - Imunoterapia

Full Text

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