Dados do Trabalho

Título

Epidemiological, clinical and therapeutic profile of progressive forms of multiple sclerosis followed up at a based reference center in the state of Ceará

Resumo

Introduction: Multiple Sclerosis (MS) is an immune-mediated, chronic inflammatory disease of the Central Nervous System (CNS), characterized by multifocal areas of demyelination in the brain and spinal cord, with infiltration of inflammatory cells, reactive gliosis and axonal degeneration. There is a knowledge gap in understanding the disease, particularly the progressive forms in different regions of the country, such as the Northeast. Objective: To report the profile of progressive MS at a reference center in Ceará. Methods: This observational and cross-sectional study was conducted through a review of medical records and interviews at a Reference Center for Demyelinating Diseases in the city of Fortaleza, Ceará. The population was composed of patients with the progressive forms of Multiple Sclerosis, registered in that center, whose diagnoses meet the criteria of McDonald 2017. Results: From 283 patients regularly followed with MS diagnosis according to the 2017 McDonald criteria, 36 (12.7%) had progressive phenotype, 20 (56%) secondary progressive and 16 (44%) primary progressive. From those 36 patients currently followed up, 25 (69,4%) were women, 19 (52,8%) were Caucasian, 18 (50%) were high educated and the majority lived in Fortaleza 25 (69.4%). The peak incidence was in the third decade of life and the peak prevalence was between the 4th and 5th decades. The median length of illness is 193 months. It is important noting that patients are many with an undiagnosed disease for years. In turn, the follow-up time in a tertiary service, when most of them had a closed diagnosis, is 61 months. Regarding disability, 27.8% already used support in the first assessment (EDSS 6.0), and in the last assessment, considering the last EDSS recorded, the percentage of patients in need of support almost doubled: 52.8%. Regarding the first disease-modifying drugs (DMD), there was a prevalence of interferons, considering that it was the most used class in the 1990s. Considering the current DMD, there is a prevalence of monoclonal antibodies (47%), with Natalizumab (25%) and Ocrelizumab (22%). In a comparative analysis, there is a drop in the use of interferons (8%). Conclusion: Understanding the epidemiological, clinical and therapeutic profile of MS patients with a progressive phenotype is essential to guide the propaedeutic reasoning, define conduct and restructure the dynamics of health services.

Palavras Chave

Multiple Sclerosis; epidemiology