Treatment Landscape of Multiple Sclerosis in Mosul: A Descriptive Cross-Sectional Study at Ibn-Sina Neurology Center
Abstract
Background: Multiple sclerosis (MS) is a chronic inflammatory demyelinating disease of the central nervous system that encompasses long-term usage of disease-modifying therapy (DMTs). In Mosul city, the availability, distribution, prescription patterns, and accessibility of such therapies is not fully explored.
Objective: To describe the current treatment landscape for MS patients at Mosul Neurology Center, including DMT usage patterns, common adverse effects reasons for therapy switching, age and gender distribution of patients, local drug availability and cost, patient satisfaction, and infrastructure conditions at the local biological therapy unit.
Methods: This descriptive cross-sectional study analyzed a random sample of 108 medical records drawn from a total cohort of 592 registered MS patients at Ibn-Sina Neurology Center. Collected data included age, gender, current DMT, prior treatment history, therapy switching, and relevant laboratory findings. The annual treatment cost of each drug class was assessed. Additionally, a structured patient questionnaire was performed in the biological therapy unit. Drug usage patterns were compared with UK and other global benchmarks.
Results: Eight drugs are currently used in the treatment spectrum of 592 registered MS patients. The pattern is coherent with international standards, but there is relatively high utilization of betaferon (21% of patients), and lack of other more useful options, like dimethyl fumarate. Fingolimod is associated with high rate of leukopenia, and betaferon is the most commonly discontinued drug. Treatment pattern is consistent with induction strategy, and analysis of annual cost shows that natalizumab is the most expensive, yet, valuable drug, followed by ocrelizumab and betaferon. Generally, 60% of patients receiving biological treatment are completely satisfied with their treatment.
Conclusion: The available DMTs landscape is fairly good, including the usage of multiple treatment options and continuous monitoring of adverse reactions. Yet, it can still be improved by reallocating resources from high-cost, lower-efficacy interferons to introducing oral agents like dimethyl fumarate.
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