Nicaraguan recommendations on the identification of treatment failure in patients with relapsing-remitting Multiple Sclerosis

Abstract

Introduction: The definition of treatment failure in Multiple Sclerosis (MS) is a central aspect of patient care, since its rapid identification and approach will prevent the progression of the disease in affected patients. The objective of the following consensus is to provide recommendations on the identification of treatment failure in patients with relapsing-remitting (RR) MS phenotype in Nicaragua. Methods: Remote survey round, carried out by a group of 5 Nicaraguan neurologists through a link that allowed access to the form to answer the statements, the degree of agreement being based on their knowledge, experience and the additional bibliography sent for your review. The assertions were made in three sections: 1) General aspects of the follow-up of patients with multiple sclerosis and identification of disease activity. 2) Importance of identifying MS activity and 3) Definition of treatment failure. The score of each statement was established in the following categories: inappropriate, doubtful and appropriate. Results: A total of 59 statements were made, which were divided into three sections; first with 28 affirmations, second with 20 affirmations and third with 11 affirmations. Of the total number of statements, 40 (67.7%) obtained the appropriate response category, 17 (28.8%) doubtful response, and 2 (3.38%) inappropriate. Conclusion: The recommendations were established based on the published evidence and the criteria of the experts who participated. The recommendations address general aspects of management, as well as the definition of patients using sustained therapies (maintenance) such as pulse therapies (reconstitution therapies) in patients with RRMS. Although there is no universally accepted definition of treatment failure, having local recommendations will allow us to optimize patient care in our setting. These recommendations seek to help the neurologist in the follow-up of patients with RRMS who do not respond to the implemented treatments.

Keywords: Multiple sclerosis, treatment failure, consensus, Nicaragua