Consenso para el diagnóstico y tratamiento de la esclerosis múltiple en pacientes
      del ISSSTE
   <br/>
      			Translated title:
      			Consensus for the diagnosis and treatment of multiple sclerosis in ISSSTE patients

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Abstract

Resumen: La esclerosis múltiple es una de las principales enfermedades desmielinizantes del sistema nervioso central, que repercute no solo en lo económico, sino también en lo social. El Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE) dispone de la mayor parte de los tratamientos que modifican la evolución de esta enfermedad y para optimizar su uso, un grupo de neurólogos de la institución se reunió para la realización de un documento sobre aspectos generales de diagnóstico y tratamiento denominado Consenso para el Diagnóstico y Tratamiento de la Esclerosis múltiple en pacientes del ISSSTE. El objetivo de este documento es dar recomendaciones de las diferentes alternativas terapéuticas contra la esclerosis múltiple.

Translated abstract

Abstract: Multiple sclerosis is one of the main demyelinating diseases of the central nervous system, which impacts not only economically but also socially. The Mexican Institute of Security and Social Services of State Workers (ISSSTE) has most of the disease modifying treatments for this disease and to optimize its use, a group of neurologists from the institution met to make a document on general aspects of diagnosis and treatment called: Consensus for the diagnosis and treatment of multiple sclerosis in ISSSTE patients. The objective of this consensus is to give recommendations on the different therapeutic alternatives against multiple scle- rosis for adults and children.

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Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria

Alan Thompson, Brenda Banwell, Frederik Barkhof … (2018)

The 2010 McDonald criteria for the diagnosis of multiple sclerosis are widely used in research and clinical practice. Scientific advances in the past 7 years suggest that they might no longer provide the most up-to-date guidance for clinicians and researchers. The International Panel on Diagnosis of Multiple Sclerosis reviewed the 2010 McDonald criteria and recommended revisions. The 2017 McDonald criteria continue to apply primarily to patients experiencing a typical clinically isolated syndrome, define what is needed to fulfil dissemination in time and space of lesions in the CNS, and stress the need for no better explanation for the presentation. The following changes were made: in patients with a typical clinically isolated syndrome and clinical or MRI demonstration of dissemination in space, the presence of CSF-specific oligoclonal bands allows a diagnosis of multiple sclerosis; symptomatic lesions can be used to demonstrate dissemination in space or time in patients with supratentorial, infratentorial, or spinal cord syndrome; and cortical lesions can be used to demonstrate dissemination in space. Research to further refine the criteria should focus on optic nerve involvement, validation in diverse populations, and incorporation of advanced imaging, neurophysiological, and body fluid markers.

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Diagnostic criteria for multiple sclerosis: 2010 Revisions to the McDonald criteria

Chris Polman, Stephen C Reingold, Brenda Banwell … (2011)

New evidence and consensus has led to further revision of the McDonald Criteria for diagnosis of multiple sclerosis. The use of imaging for demonstration of dissemination of central nervous system lesions in space and time has been simplified, and in some circumstances dissemination in space and time can be established by a single scan. These revisions simplify the Criteria, preserve their diagnostic sensitivity and specificity, address their applicability across populations, and may allow earlier diagnosis and more uniform and widespread use. Ann Neurol 2011

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Alemtuzumab versus interferon beta 1a as first-line treatment for patients with relapsing-remitting multiple sclerosis: a randomised controlled phase 3 trial.

Jeffrey A Cohen, Alasdair J Coles, Douglas L Arnold … (2012)

The anti-CD52 monoclonal antibody alemtuzumab reduced disease activity in a phase 2 trial of previously untreated patients with relapsing-remitting multiple sclerosis. We aimed to assess efficacy and safety of first-line alemtuzumab compared with interferon beta 1a in a phase 3 trial. In our 2 year, rater-masked, randomised controlled phase 3 trial, we enrolled adults aged 18-50 years with previously untreated relapsing-remitting multiple sclerosis. Eligible participants were randomly allocated in a 2:1 ratio by an interactive voice response system, stratified by site, to receive intravenous alemtuzumab 12 mg per day or subcutaneous interferon beta 1a 44 μg. Interferon beta 1a was given three-times per week and alemtuzumab was given once per day for 5 days at baseline and once per day for 3 days at 12 months. Coprimary endpoints were relapse rate and time to 6 month sustained accumulation of disability in all patients who received at least one dose of study drug. This study is registered with ClinicalTrials.gov, number NCT00530348. 187 (96%) of 195 patients randomly allocated interferon beta 1a and 376 (97%) of 386 patients randomly allocated alemtuzumab were included in the primary analyses. 75 (40%) patients in the interferon beta 1a group relapsed (122 events) compared with 82 (22%) patients in the alemtuzumab group (119 events; rate ratio 0·45 [95% CI 0·32-0·63]; p<0.0001), corresponding to a 54·9% improvement with alemtuzumab. Based on Kaplan-Meier estimates, 59% of patients in the interferon beta 1a group were relapse-free at 2 years compared with 78% of patients in the alemtuzumab group (p<0·0001). 20 (11%) of patients in the interferon beta 1a group had sustained accumulation of disability compared with 30 (8%) in the alemtuzumab group (hazard ratio 0·70 [95% CI 0·40-1·23]; p=0·22). 338 (90%) of patients in the alemtuzumab group had infusion-associated reactions; 12 (3%) of which were regarded as serious. Infections, predominantly of mild or moderate severity, occurred in 253 (67%) patients treated with alemtuzumab versus 85 (45%) patients treated with interferon beta 1a. 62 (16%) patients treated with alemtuzumab had herpes infections (predominantly cutaneous) compared with three (2%) patients treated with interferon beta 1a. By 24 months, 68 (18%) patients in the alemtuzumab group had thyroid-associated adverse events compared with 12 (6%) in the interferon beta 1a group, and three (1%) had immune thrombocytopenia compared with none in the interferon beta 1a group. Two patients in the alemtuzumab group developed thyroid papillary carcinoma. Alemtuzumab's consistent safety profile and benefit in terms of reductions of relapse support its use for patients with previously untreated relapsing-remitting multiple sclerosis; however, benefit in terms of disability endpoints noted in previous trials was not observed here. Genzyme (Sanofi) and Bayer Schering Pharma. Copyright © 2012 Elsevier Ltd. All rights reserved.

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Journal

Journal ID (publisher-id): mim

Title: Medicina interna de México

Abbreviated Title: Med. interna Méx.

Publisher: Edición y Farmacia S.A. de C.V. (Ciudad de México, Ciudad de México, Mexico )

ISSN (Print): 0186-4866

Publication date (Print and electronic): October 2019

Volume: 35

Issue: 5

Pages: 732-771

Affiliations

[7] Ciudad de México orgnameInstituto de Seguridad y Servicios Sociales de los Trabajadores del Estado orgdiv1Centro Médico Nacional 20 de Noviembre México

[6] Monterrey Nuevo Léon orgnameInstituto de Seguridad y Servicios Sociales de los Trabajadores del Estado orgdiv1Hospital Regional México

[14] Ciudad de México orgnameInstituto de Seguridad y Servicios Sociales de los Trabajadores del Estado orgdiv1Centro Médico Nacional 20 de Noviembre México

[3] Colima orgnameInstituto de Seguridad y Servicios Sociales de los Trabajadores del Estado orgdiv1Clínica Hospital Dr. Miguel Trejo Ochoa México

[11] Zapopan Jalisco orgnameInstituto de Seguridad y Servicios Sociales de los Trabajadores del Estado orgdiv1Hospital Regional Dr. Valentín Gómez Farías México

[8] Zapopan Jalisco orgnameInstituto de Seguridad y Servicios Sociales de los Trabajadores del Estado orgdiv1Hospital Regional Dr. Valentín Gómez Farías México

[1] Ciudad de México orgnameInstituto de Seguridad y Servicios Sociales de los Trabajadores del Estado México

[12] Durango orgnameInstituto de Seguridad y Servicios Sociales de los Trabajadores del Estado orgdiv1Hospital General Dr. Santiago Ramón México

[13] Ciudad de México orgnameInstituto de Seguridad y Servicios Sociales de los Trabajadores del Estado orgdiv1Centro Médico Nacional 20 de Noviembre México

[4] Veracruz orgnameInstituto de Seguridad y Servicios Sociales de los Trabajadores del Estado México

[10] Zapopan Jalisco orgnameInstituto de Seguridad y Servicios Sociales de los Trabajadores del Estado orgdiv1Hospital Regional Dr. Valentín Gómez Farías México

[2] San Luis Potosí orgnameInstituto de Seguridad y Servicios Sociales de los Trabajadores del Estado orgdiv1Hospital General México

[15] Zapopan Jalisco orgnameInstituto de Seguridad y Servicios Sociales de los Trabajadores del Estado orgdiv1Hospital Regional Dr. Valentín Gómez Farías México

[5] Ciudad de México orgnameInstituto de Seguridad y Servicios Sociales de los Trabajadores del Estado orgdiv1Hospital Regional Lic. Adolfo López Mateos México

[9] Ciudad de México orgnameInstituto de Seguridad y Servicios Sociales de los Trabajadores del Estado orgdiv1Clínica de Especialidades Indianilla

Article

Publisher ID: S0186-48662019000500732 Publisher ID: S0186-4866(19)03500500732

DOI: 10.24245/mim.v35i5.3284

SO-VID: 3139e40a-4089-42d4-873d-b1713e456630

License:

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

History

Date accepted : 02 July 2019

Date received : 19 June 2019

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Figures: 0, Tables: 0, Equations: 0, References: 100, Pages: 40

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Consenso para el diagnóstico y tratamiento de la esclerosis múltiple en pacientes del ISSSTE Translated title: Consensus for the diagnosis and treatment of multiple sclerosis in ISSSTE patients

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Abstract

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SciELO Mexico

Most cited references 95

Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria

Diagnostic criteria for multiple sclerosis: 2010 Revisions to the McDonald criteria

Alemtuzumab versus interferon beta 1a as first-line treatment for patients with relapsing-remitting multiple sclerosis: a randomised controlled phase 3 trial.

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