Focused on MS: Statistics Are Boring, But They Have Valuable Data!

Multiple sclerosis (MS) was first described by Jean-Martin Charcot in 1868. Since then, knowledge about this disease has continually increased. However, many unanswered questions remain. Have we managed to answer some of them through meticulous epidemiological data collection?

Increasing Prevalence and Proportion of Pediatric Patients

The output of the international project MS Atlas, covering 115 countries and approximately 87% of the world's population, highlighted a 30% increase in the number of MS patients compared to 2013 data. Currently, 2.8 million people worldwide are diagnosed with MS. The global prevalence is therefore 35.9 cases per 100,000 people. This increase occurred in nearly all monitored regions. The incidence corresponds to 2.1 new cases per 100,000 people per year. It is also still true that the occurrence of MS is approximately twice as high in women.

The number of pediatric patients is also increasing. In the 2020 output of the MS Atlas project, 7,000 cases were reported from 34 countries, while in the latest output, a total of 47 countries reported more than 30,000 children suffering from MS. Most experts view these findings positively – improved diagnostics, better data collection, and increased survival rates.

Disease-Modifying Drugs Are Not a Given

In the Czech Republic, fortunately, all disease-modifying drugs (DMDs) approved by the European Medicines Agency (EMA) are available for patients. Newly, reimbursement for highly effective therapies (HET) is possible even after the first attack. However, this is not the case worldwide. In a quarter of countries, HETs are not available, and in 14% of countries, no long-term therapy is available.

No Place Like Home!

The outputs from the Czech national registry of MS patients − ReMuS, are also interesting. In the latest comprehensive report published as of 31 December 2020, 11,604 DMDs and 2,993 non-DMDs patients were analyzed after excluding patients without current data. Women represented 71.6% of these patients, the average age at the last visit was 43.0 years, and the average age at the onset of the disease was 31.5 years. In total, 99.7% of patients were over 18 years old at the last visit, 78.4% of those up to 65 years old worked full or part-time, and 31.2% were on disability pension. The largest group in terms of the degree of disability were patients with a score of 1.5 on the Kurtzke Expanded Disability Status Scale (EDSS). The average annual relapse rate (ARR) was 0.174. The ratio of patients treated with basic and highly effective DMDs is also important. In 2013, the proportion of patients on HET was 16%, in 2018 it was a third, and in 2020 it was 40%.

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Sources:

1. Walton C., King R., Rechtman L. et al. Rising prevalence of multiple sclerosis worldwide: insights from the Atlas of MS, third edition. Mult Scler 2020; 26 (14): 1816–1821, doi: 10.1177/1352458520970841.
2. Dobson R., Giovannoni G. Multiple sclerosis − a review. Eur J Neurol 2019; 26 (1): 27–40, doi: 10.1111/ene.13819.
3. Atlas of MS 2020 – Epidemiology report. Multiple Sclerosis International Federation, 2020. Available at: www.msif.org/resource/atlas-of-ms-2020
4. Regular output from the ReMuS registry. Data export as of 31 December 2020 – summary of results from the analysis. Nadační fond IMPULS, 24 March 2021. Available at: https://nfimpuls.cz/images/docs/remus_zaverecne-zpravy/zaverecna_zprava_2020_12_souhrnna_web.pdf
5. Horáková D. How we monitor highly effective drugs for MS. 33rd Czech and Slovak Neurological Congress, 31 March 2022.