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Impact of delayed treatment on exacerbations of multiple sclerosis among Puerto Rican patients

BACKGROUND: There are limited data on multiple sclerosis (MS) patients in underserved groups, including Puerto Rico. In this study, we analyzed the characteristic of MS symptoms and number of relapses in Puerto Rican patients. We then compare these characteristics with MS patients from the US. The n...

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Autores principales: Zarei, Sara, Maldonado, Irvin, Franqui-Dominguez, Laura, Rubi, Cristina, Rosa, Yanibel Tapia, Diaz-Marty, Cristina, Coronado, Guadalupe, Nieves, Marimer C. Rivera, Akhlaghipour, Golnoush, Chinea, Angel
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Scientific Scholar 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6826276/
https://www.ncbi.nlm.nih.gov/pubmed/31768280
http://dx.doi.org/10.25259/SNI_252_2019
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author Zarei, Sara
Maldonado, Irvin
Franqui-Dominguez, Laura
Rubi, Cristina
Rosa, Yanibel Tapia
Diaz-Marty, Cristina
Coronado, Guadalupe
Nieves, Marimer C. Rivera
Akhlaghipour, Golnoush
Chinea, Angel
author_facet Zarei, Sara
Maldonado, Irvin
Franqui-Dominguez, Laura
Rubi, Cristina
Rosa, Yanibel Tapia
Diaz-Marty, Cristina
Coronado, Guadalupe
Nieves, Marimer C. Rivera
Akhlaghipour, Golnoush
Chinea, Angel
author_sort Zarei, Sara
collection PubMed
description BACKGROUND: There are limited data on multiple sclerosis (MS) patients in underserved groups, including Puerto Rico. In this study, we analyzed the characteristic of MS symptoms and number of relapses in Puerto Rican patients. We then compare these characteristics with MS patients from the US. The number of MS relapses is highly correlated with the treatment onset and adherence. Patients in Puerto Rico have been experiencing lengthy treatment delay. We will discuss the possible causes of such delay and its impact on MS prognosis. METHODS: This retrospective cohort study consisted of the evaluation of 325 medical records from MS patients attending the Caribbean Neurological Center from 2014 to 2019. We gathered symptoms and comorbidities data as binary objects. The treatment delay was calculated based on the mean value of days between diagnosis and treatment onset for these groups of patients. RESULTS: We found that on average, the treatment delay for MS patients in Puerto Rico (PR) to receive their medication was 120 days. The most common MS subtype was relapsing-remitting 72.8%, with a mean of 1.684 relapses per year. Initial symptoms were sensory 54%, visual 33.1%, motor 28.8%, coordination 23.2%, fatigue 9.7%, memory 7.3%, depression 6.5%, urinary 4.9%, gastrointestinal 2.4%, and sexual dysfunction 1.6%. The most common comorbidities were hypertension 18.4%, asthma 13.6%, and thyroid disease 12.8%. When we compared the comorbidities between the two populations, immune thrombocytopenia had the highest percent change with the value of almost 200% (0.001% of US patient vs. 0.8% of Puerto Rican MS patients). CONCLUSION: Patients from Puerto Rico had a 33% higher relapse rate compared to the one reported for MS patients in the US. This higher rate may be related to the long delay in receiving their medications. They also had a higher rate of complex comorbidities such as immune thrombocytopenia or thyroid disease. Our findings provide a proof of concept that delay in receiving medications can increase the number of relapses and complex comorbidities among MS patients.
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spelling pubmed-68262762019-11-25 Impact of delayed treatment on exacerbations of multiple sclerosis among Puerto Rican patients Zarei, Sara Maldonado, Irvin Franqui-Dominguez, Laura Rubi, Cristina Rosa, Yanibel Tapia Diaz-Marty, Cristina Coronado, Guadalupe Nieves, Marimer C. Rivera Akhlaghipour, Golnoush Chinea, Angel Surg Neurol Int Original Article BACKGROUND: There are limited data on multiple sclerosis (MS) patients in underserved groups, including Puerto Rico. In this study, we analyzed the characteristic of MS symptoms and number of relapses in Puerto Rican patients. We then compare these characteristics with MS patients from the US. The number of MS relapses is highly correlated with the treatment onset and adherence. Patients in Puerto Rico have been experiencing lengthy treatment delay. We will discuss the possible causes of such delay and its impact on MS prognosis. METHODS: This retrospective cohort study consisted of the evaluation of 325 medical records from MS patients attending the Caribbean Neurological Center from 2014 to 2019. We gathered symptoms and comorbidities data as binary objects. The treatment delay was calculated based on the mean value of days between diagnosis and treatment onset for these groups of patients. RESULTS: We found that on average, the treatment delay for MS patients in Puerto Rico (PR) to receive their medication was 120 days. The most common MS subtype was relapsing-remitting 72.8%, with a mean of 1.684 relapses per year. Initial symptoms were sensory 54%, visual 33.1%, motor 28.8%, coordination 23.2%, fatigue 9.7%, memory 7.3%, depression 6.5%, urinary 4.9%, gastrointestinal 2.4%, and sexual dysfunction 1.6%. The most common comorbidities were hypertension 18.4%, asthma 13.6%, and thyroid disease 12.8%. When we compared the comorbidities between the two populations, immune thrombocytopenia had the highest percent change with the value of almost 200% (0.001% of US patient vs. 0.8% of Puerto Rican MS patients). CONCLUSION: Patients from Puerto Rico had a 33% higher relapse rate compared to the one reported for MS patients in the US. This higher rate may be related to the long delay in receiving their medications. They also had a higher rate of complex comorbidities such as immune thrombocytopenia or thyroid disease. Our findings provide a proof of concept that delay in receiving medications can increase the number of relapses and complex comorbidities among MS patients. Scientific Scholar 2019-10-11 /pmc/articles/PMC6826276/ /pubmed/31768280 http://dx.doi.org/10.25259/SNI_252_2019 Text en Copyright: © 2019 Surgical Neurology International http://creativecommons.org/licenses/by-nc-sa/4.0 This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
spellingShingle Original Article
Zarei, Sara
Maldonado, Irvin
Franqui-Dominguez, Laura
Rubi, Cristina
Rosa, Yanibel Tapia
Diaz-Marty, Cristina
Coronado, Guadalupe
Nieves, Marimer C. Rivera
Akhlaghipour, Golnoush
Chinea, Angel
Impact of delayed treatment on exacerbations of multiple sclerosis among Puerto Rican patients
title Impact of delayed treatment on exacerbations of multiple sclerosis among Puerto Rican patients
title_full Impact of delayed treatment on exacerbations of multiple sclerosis among Puerto Rican patients
title_fullStr Impact of delayed treatment on exacerbations of multiple sclerosis among Puerto Rican patients
title_full_unstemmed Impact of delayed treatment on exacerbations of multiple sclerosis among Puerto Rican patients
title_short Impact of delayed treatment on exacerbations of multiple sclerosis among Puerto Rican patients
title_sort impact of delayed treatment on exacerbations of multiple sclerosis among puerto rican patients
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6826276/
https://www.ncbi.nlm.nih.gov/pubmed/31768280
http://dx.doi.org/10.25259/SNI_252_2019
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