| Background: Iran, as a middle income country, is one of the places with high and rising
prevalence of multiple sclerosis (MS). Regarding the substantial economic burden, reviewing the
trend in prescribed disease modifying treatments (DMTs) could be of help. Here we studied the
DMT information of nearly 14000 MS cases and its trends change for 30 years to improve health
services to patients
Methods: The population base of this descriptive-analytical (cross-sectional) study consisted of
all MS patients in nationwide MS registry of Iran (NMSRI), up to August 1, 2021. Registrars
from 15 provinces, 24 cities, 13 hospitals,8 MS associations, 16 private offices, and 7 clinics had
entered the data
Results: Overall, 14316 cases were enrolled. The majority (76.1%) were female. The youngest
and eldest patients were 5 and 78 years old, respectively. Diagnosis delay was under one year in
most cases (median: 0, IQR: 0 – 1). Most (61.4%) involved RRMS. Generally, platform
injectables (IFN beta, glatiramer acetate) were the most used DMTs until 2010. It seems that
introduction of newer agents (antiCD20s and oral DMTs) resulted in a decrease in the use of
former drugs since around 2015. Some unusual practices are prominent such as using not
approved DMTs for PPMS over the years, or administering high efficacy drugs like natalizumab
for CIS. The results indicate the remaining popularity of first line injectable DMTs in female and
pediatric patients
Discussion: Mean age (SD) at onset in our study (29 ± 8.8) is near the statistics in Asia and
Oceania (28 ± 0.7). Concerns about COVID-19 had a noticeable impact on administering high
efficacy drugs like rituximab and fingolimod. However, in male patients this approach has not
been the case. It may be related to more aggressive disease course in this group. The other
possible explanation could be planning for pregnancy in female cases. The popularity of platform
injectable drugs in pediatric MS may be related to its favorable safety profile over the years.
Another point in this group, is the superiority of rituximab over other highly efficient
medications. |