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. 2020 Jan 9;6(1):2055217319848466.
doi: 10.1177/2055217319848466. eCollection 2020 Jan-Mar.

Treatment of multiple sclerosis in special populations: The case of refugees

Maya M Zeineddine  1 , Bassem I Yamout  1
Affiliations

Treatment of multiple sclerosis in special populations: The case of refugees

Maya M Zeineddine et al. Mult Scler J Exp Transl Clin. .

Abstract

Multiple sclerosis was long considered a relatively rare entity in the Middle East, but research over the past 10 years and the publication of the Middle East North Africa Committee for Treatment and Research in Multiple Sclerosis guidelines for multiple sclerosis have allowed diagnosis and treatment to occur more efficiently. Most of the first and second-line disease-modifying therapies approved by the Food and Drug Administration and the European Medicine Agency are available in the Middle East. However, the availability of disease-modifying therapies is quite variable, with some countries having access to all multiple sclerosis disease-modifying therapies, while in others there is only one therapeutic option. Economic limitations remain a challenge for the management of multiple sclerosis, especially in countries of war. Moreover, the burden of multiple sclerosis treatment in Syrian and Palestinian refugees is likely high due to the non-availability of funds to cover the high cost of disease-modifying therapies.

Keywords: Middle East; Palestinian; Syrian; Treatment; multiple sclerosis; refugees.

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Figures

Figure 1.
Figure 1.
Algorithm for the management of relapsing–remitting multiple sclerosis. Adopted from Consensus recommendations for the diagnosis and treatment of multiple sclerosis: The Middle East North Africa Committee for Treatment and Research In Multiple Sclerosis (MENACTRIMS).
Figure 2.
Figure 2.
Disease-modifying therapies for Syrian and Palestinian refugees treated at the Nehme and Therese Tohme Multiple Sclerosis Center. (a) Palestinian refugees (n = 37) and (b) Syrian refugees (n = 142). AZA: azathiopribe; CIS: clinically isolated syndrome; DMF: dimethyl fumarate; IFN: interferons; MMF: mycophenolate mofetil; NMO: neuromyelitis optica; PMS: progressive multiple sclerosis; RIS: radiologically isolated syndrome; RRMS: relapsing–remitting multiple sclerosis; RTX: rituximab; Tx: treatment.
Figure 3.
Figure 3.
Disease-modifying therapies for all refugees (n=179) treated at the Nehme and Therese Tohme Multiple Sclerosis Center. AZA: azathioprine; DMF: dimethyl fumarate; IFN: interferons; MMF: mycophenolate mofetil; Tx: treatment.
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