Regional Variations in Multiple Sclerosis Epidemiology and Healthcare Access: Insights from the BRANDO Database in Brazil

Abstract

Results: A total of 226 women with MS and 269 pregnancies were included in this analysis. The outcomes comprised 36 miscarriages , 40 preterm births, and 193 full-term deliveries. The age of women in these groups did not significantly differ (p>0.05 for each; mean age: miscarriages 32.25, preterm 30.05, full-term 29.98). The majority of the cohort used interferon (119), glatiramer acetate (47), and fingolimod (47) before pregnancy. Some women who used fingolimod did not discontinue their DMT before pregnancy (18/47), and this did not significantly affect the rates of preterm birth or miscarriage compared to those who stopped their DMT. However, partum relapses were higher in women who discontinued fingolimod before pregnancy (p<0.019; 6 of 18 experienced relapses). No significant differences in partum relapse rates were found for other DMTs between those who discontinued use and those who did not (p>0.05). Conclusion: The findings suggest that exposure to DMTs during pregnancy may not significantly impact the rates of miscarriage or preterm birth. However, discontinuing fingolimod before pregnancy may increase the risk of MS activity during pregnancy. These preliminary results indicate that further extensive research is needed to better understand the relationship between DMT exposure and pregnancy outcomes in women with MS, and to develop guidelines for managing MS treatment during pregnancy. Introduction: Multiple Sclerosis (MS) is an inflammatory and neurodegenerative disorder. The prevalence of MS varies across Brazil (15 to 18 per 100,000 on average-South: 27 per 100,000) and the absence of an extensive national study limits the understanding of MS epidemiology in a nation as diverse as Brazil. Objectives/Aims: To compare epidemiological data, including health care access, among people with MS across four Brazilian regions. Methods: Data from 2974 Brazilian MS patients in the Collaborative Latin American Database for Multiple Sclerosis (BRANDO) were analysed. We assessed demographic (sex, eth-nicity), clinical outcomes (age at onset, disability status, relapse frequency and topography, MS phenotype, initial treatment) and health care assessment (times frame [years]: first relapse until MS diagnosis, first relapse until first access to disease modified therapies-DMTs, MS diagnosis until first access to DMTs) to elucidate regional differences. Results: The cohort was predominantly female (72.5%) with MS onset age of 30.6 years. Regional differences: Lower predominance of female (68.7%, p=.003) in the Southeast; higher Mixed ethnicity (p=.000), 40.3% and 63.7%, in the Central-West and Northeast, respectively; differences (p=.000) in number of relapses (Southeast [1.6] = Northeast [1.5]> South [.98] > Central-West [.51]); higher EDSS score in Northeast (4.0, p=.000) compared to all other regions (mean range, 2.6-3.2); higher prevalence of RR in the Southeast and Central-West (87%, p<.001), while the Northeast presented (p<.001) the highest rates of primary progressive (15.8%) and secondary progressive MS (18%). Glatiramer acetate (19.7%) was the prevalent initial treatment in Northeast compared to natal-izumab (15%-21%) in the other regions. Northeast had the longest time (5.9, p<0.01) from the first relapse until MS diagnosis (other regions =1.9-3.7). Central-West showed the shortest time (2.1, p<0.01) from first relapse until first access to DMTs (other regions = 3.5-5.1). Southeast had the shortest time (2.3, p=0.05), and Northeast the longest time (8.3, p=0.05) from MS diagnosis until first access to DMTs (South=4.7, Central-West=4.8).