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New Atlas of MS identifies global gaps in MS clinical management

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28 April 2021

The MS International Federation has just launched the second part of its update to the Atlas of MS. This 3rd Edition of the Atlas examined clinical management of MS around the world, particularly focusing on barriers to accessing healthcare and disease modifying therapies (DMTs).

The Atlas provides unique insights, in that it is not a standard review of the published literature, but rather reaches out to organisations and experts in every country in the world for the most up-to-date information on MS. There were 138 countries enrolled to take part in the survey from late 2019 to early 2020. Mr Andrew Giles of MS Australia and epidemiologist Professor Ingrid van der Mei, who leads the Australian MS Longitudinal Study, were the Australian representatives guiding development of this project.

The Atlas found that the majority (83%) of countries worldwide experience barriers to early diagnosis of MS. A significant number (14%) of countries have no licensed DMTs available, while 25% of countries worldwide do not have access to the most effective therapies (defined as natalizumab, alemtuzumab, and ocrelizumab). Many countries (72%) reported barriers to accessing DMTs, with the most common barrier being cost to government, healthcare system or insurance provider. Almost half of the countries had difficulties with continuous access to DMTs, due to irregular supply or access to reimbursements or eligibility tests.

The Atlas found a high unmet need for rehabilitation and symptom management in MS, especially in low and middle income countries; and that therapies for fatigue and cognitive impairment were unavailable in two fifths of countries. The Atlas cited a landmark report, authored by MS Australia’s Bea Beswick, noting the crucial role of MS Specialist nurses in supporting people with MS and their families. Sadly, almost two thirds of the world’s population of people with MS live in countries without national guidelines for diagnosis and treatment of MS, and without national standards for MS care in place. Only 19% of countries endorse and follow to some extent the MS Brain Health International standards for MS clinical care, released in 2019, to maximise lifelong brain health.

Chair of the MSIF Board, Professor Mai Sharawy says, “this 3rd edition of the Atlas of MS shines a spotlight on the barriers to accessing diagnosis and disease modifying therapies around the world. These issues are particularly evident in low and middle income countries but high income countries are not exempt.” The Atlas is a powerful tool to raise awareness and drive change. Professor Sharawy notes it “should be used to guide policy-makers, health planners and specialists, in order to close the gaps in care, decrease inequities globally, and provide a better future for people with MS and their families.” (Reference: The Multiple Sclerosis International Federation – Atlas of MS – 3rd Edition, part 2: clinical management of multiple sclerosis around the world (April 2021)).

MS Australia and its research arm, MS Research Australia, are active members of the MS International Federation and continue their support of the Atlas of MS initiative. We commend this 3rd edition of the Atlas of MS to readers in the MS community and to researchers interested in following the work of the global MS movement.