[Compliance of the guidelines of the Spanish Neurology Society in the treatment of patients with multiple sclerosis].

Revista de neurologia

PubMedID: 26204085

Oreja-Guevara C, Rio J, Gobartt AL, En Nombre Del Grupo de Investigadores Del Estudio Futura EN. [Compliance of the guidelines of the Spanish Neurology Society in the treatment of patients with multiple sclerosis]. Rev Neurol. 2015;61(4):145-52.
INTRODUCTION
Treatment of multiple sclerosis is based on the administration of the disease modifying drugs (DMD), used to slow the natural course of the disease.

AIM
To assess the degree of compliance of Spanish neurologists with 2010 Spanish Neurology Society (SEN) treatment guidelines.

PATIENTS AND METHODS
Observational, retrospective and multicenter study of 218 adult patients with at least five years of disease evolution and under treatment with DMD. Data on their past/current management was obtained from their medical records and descriptively compared to SEN recommendations.

RESULTS
According to SEN 2010 guidelines, 82% of patients had an adequate clinical response and 18% had an inadequate clinical response to their current DMD; 94% and 92%, respectively, maintained that treatment. Patients in which inadequate clinical response did not motivate a change in the current DMD more frequently had higher disability decline and higher number of relapses during previous treatments, and longer treatment duration with their current DMD. Regarding the sequence of DMDs used, 48% of patients initiated first-line treatment with interferon beta-1a administered through subcutaneous (29%) or intramuscular injections (19%), followed by interferon beta-1b, and glatiramer acetate. Some patients received second-line treatments as second/third option (15% and 28% respectively), but these treatments (mostly natalizumab) were only widespread from fourth treatment onwards.

CONCLUSIONS
In accordance with SEN 2010 guidelines, the majority of patients from the study had an adequate clinical response. A high percentage of patients with an inadequate clinical response remained with their current treatment. An explanation to this phenomenon could be found in the chronic, complex and variable nature of multiple sclerosis.