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

Sara Zarei; Irvin Maldonado; Laura Franqui-Dominguez; Cristina Rubi; Yanibel Tapia Rosa; Cristina Diaz-Marty; Guadalupe Coronado; Marimer C Rivera Nieves; Golnoush Akhlaghipour; Angel Chinea

doi:10.25259/SNI_252_2019

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

Surg Neurol Int. 2019 Oct 11:10:200. doi: 10.25259/SNI_252_2019. eCollection 2019.

Affiliations

¹ Department of Neurology, San Juan Bautista School of Medicine, Caguas, Puerto Rico, USA.
² Caribbean Neurological Center, Guaynabo, USA.
³ Department of Neurology, University of California, Los Angeles, California, USA.

Abstract

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.

Keywords: Adverse impact of multiple sclerosis treatment delay; Multiple sclerosis comorbidities; Multiple sclerosis symptoms; Multiple sclerosis treatment; Puerto Rican multiple sclerosis patients; Puerto Rico health- care system.