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Título

Therapeutic inertia and functional disability in multiple sclerosis

Resumo

Introduction: Multiple sclerosis (MS) is an autoimmune demyelinating neurological disease that develops a chronic degenerative and inflammatory condition. After the onset of symptoms, it can take time before diagnosis and initiation of treatment. This therapeutic inertia can have deleterious impacts on the individual's functional capacity. Objective: To analyze the association between therapeutic inertia time and functional disability in MS. Methods: Cross-sectional, single-center study conducted with patients diagnosed with multiple sclerosis according to the 2017 McDonald criteria. The time of therapeutic inertia was calculated based on the dates of symptom onset and start of pharmacological treatment for MS. The degree of disability was expressed according to the EDSS. The sequelae were grouped into syndromes, namely optic neuritis syndrome, transverse myelitis syndrome, brainstem syndrome, mixed syndrome, and other symptoms. Results: 187 patients were admitted, of whom 20 (10.7%) were diagnosed with primarily progressive multiple sclerosis (PPMS) and 154 (82.4%) with relapsing remitting multiple sclerosis (RRMS). The mean time to therapeutic inertia was 31.96 (SD±45.56) months, with 110 (58.8%) patients with inertia less than 32 months and 56 (29.9%) patients with inertia greater than or equal to 32 months. The median EDSS score was 2 (IQR 1-4). Regarding the presence of sequelae: 1 (0.5%) was classified with optic neuritis syndrome, 10 (5.3%) with transverse myelitis syndrome, 2 (1.1%) with brainstem syndrome, 154 (82.4%) with mixed syndrome and 13 (7%) with other symptoms. 7 (3.7%) patients had no sequelae. Time of therapeutic inertia greater than or equal to 32 months was associated with higher EDSS scores [median 4 (IQR 1-6) vs 1.75 (IQR 0-3.5); p=0.001] and these more often had EMPP (x²=11.402, 70.6% vs 29.5%, p=0.001). Conclusion: Greater therapeutic inertia was associated with more impaired functional capacity and a clinical form with worse disease progression. Thus, possible factors that delay the initiation of pharmacological therapy should be investigated in clinical practice, considering their impacts on the natural history of the disease. Prospective studies can better explore this relationship and the possibilities of intervention on therapeutic inertia in MS patients.