disclosure · 2018. 10. 9. · disclosure edgardo cristiano department of neurology italian...
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Disclosure
Edgardo CristianoDepartment of NeurologyItalian Hospital of Buenos AiresBuenos Aires, Argentina
Declared declared receipt of grants and contract from: Merck, Novartis and of honoraria and consultation fees from: Biogen, Merck, Novartis. He declared also participation in a company sponsored speaker’s bureau: Biogen, Merck, Novartis, Genzyme, Roche.
Multiple Sclerosis in Latin America: epidemiology and clinical severity
E. Cristiano
Argentina
AmerindiansAsiaticAfricansMestizosMulatosCaucasianZambosTri-racial(Africans – Amerindian– European)
Latitude 32º north
Multiple Sclerosis in Caucasian and Latino Americans. Autoimmunity 2011: 44: 571-575
Latin America
Surface: 21.069.500 Km2
Population: 580.000.000 inhab
Latitude 56º south
Languages: spanish and portuguese
Prevalence, incidence and genetics
Kurtzke JF. The geographical distribution of multiple sclerosis – An update with special reference to
Europe and the Mediterranean region Acta Neurol Scand 1980; 62: 65-80
1980
MS Atlas 2013 (https://www.msif.org/wp-content/uploads/2014/09/Atlas-of-MS.pdf )
Cristiano E et al. Multiple Sclerosis Journal 2012; 0: 1-11
Cristiano E et al. Multiple Sclerosis Journal 2012; 0: 1-11
Prevalence studies
Lower prevalence in Ecuador, Colombia and Panamá(0.75 a 6.5/100.000 inhab.)
Higher prevalence in Brazil and Argentina(12-21.5/100.000 inhab.)
High dispersion in the other areas
Cristiano E et al. Multiple Sclerosis Journal 2012; 0: 1-11
Incidence studies
Phenotypes
Only 3 countries evaluated incidence: French West Indies, Panama and Argentina
(0.60 a 1.76/100.000 person/year)
The most prevalent phenotype was relapsing-remitting
• Argentina (12 – 20 - 38 / 100.000 )
• Brasil (4.3 – 15 – 18.1 / 100.000)
• Colombia (1.48 – 4.98 / 100.000)
• México (1.6 – 6.3 – 13.0 / 100.000)
Prevalence increases in successive studies
Estimated prevalence:
13.5-19.8/100.000 inh.
Cristiano et al. Eur J Neurol 2009; 16: 183-187
• Área geográfica:• C.A.B.A. y gran Buenos Aires
• Superficie: 4758 km2
• Población: 12.594.974 habitantes (Censo 1990)
• Clima subtropical
• Fuentes de información:• EMA (Asociación de pacientes)
• Hospital Italiano de Buenos Aires
• Hospital Británico
• Hospital Ramos Mejía
• Área geográfica:• C.A.B.A. y gran Buenos Aires
• Superficie: 4758 km2
• Población: 12.806.866 habitantes (Censo 2010)
• Clima subtropical
• Fuentes de información:• ALCEM (Asociación de pacientes)
• Hospital Italiano de Buenos Aires
• Hospital Británico
• Hospital Ramos Mejía
• FLENI
• INEBA
Estimated total size Confidence Interval % Prevalence rate (per 100.000) 95%CI
4901 4623 - 5276 38.2 36.1 – 41.2
Estimated prevalence: 38.2/100.000 inh.
Multiple Sclerosis and Related Disorders 9 (2016) 91–94
Incidence density: 1.76 cases/year/100,000 persons
Eur J Neurol 2010; 17: 479-482
Se observó un incremento en la densidad de incidencia
(3/100.000/año) respecto del estudio previo
Cristiano et al. Neurol SCI 2016; 37: 1621-1626
Results: 165,456 subjects were followed for a total of 1,488,575 person-years, of whom 42 developed MS. Incidence density was 3/100,000 person-years (95% CI: 2.1 – 3.5/100,000 person-years). During this period (1992-2013), the incidence rate in women increased from 1/100,000 (95%CI 0.8-1.6) to 4.9/100,000 (95%CI 4.1-5.4) (p<0.001), while in men the incidence ranged from 1.4/100,000 (95%CI 1-1.7) to 1.8 (1.3-2.1) (p=0.16)
1,4
4,9
1,8
3,0
, Neurol Sci, June 2016
Multiple Sclerosis 2008; 14: 656-662
• Ubicada en el extremo sur del continente americano• Latitud: -39° y -55°S• Superficie: 1.768.165 km2• Abarca las provincias más australes de:
• Neuquén• Río Negro• Chubut• Santa Cruz• Tierra del Fuego
• Población: 40.117.096 habitantes (INDEC – Censo 2010)
• Clima desértico y semidesértico
11 a 69/100.000NO differences between -20º y -55º
18/100.000
1318
MS disease course in Latinamerica
RRMS was the more prevalent subtype (48 – 91%)
Multiple Sclerosis – Published on line 8 october 2012
Rojas et al. MSJ Experimental Translational Clinical 2015; 1: 1-6
Rojas et al. MSJ Experimental Translational Clinical 2015; 1: 1-6
No differencies found between regions nor hemisphers regarding disease severity (MSSS)
Rojas et al. Multiple Sclerosis and Related Disorders 2016; 6: 54-56
Se observó una anticipación en la
edad de inicio en las generaciones
más jóvenes de las formas familiares
Genes and environment
Studies in native populations
Lacandones - México
• Clinical and epidemiological data were obtained from 5,372 Lacandonias• 350 DNA samples were obtained
• NO persons with MS or NMO symptoms were identified
Activación de la función
supresora de las Treg
(IL10 - TGF)
Apoptosis
Inhibición de la
activación
Ann Neurol 2007; 61: 97-108
Ann Neurol 2007; 61: 97-108
Low-medium prevalence in LATAM
• Probable reasons:
– Genetic background
• Very heterogeneous population
• Protective genes (?)
– Environmental factors
• Solar exposure
• Vitamin D levels
• Diet
• Hygiene hypothesis
– Subdiagnosis
• Large emerging data from Latam in the last 20 years
• Low-medium risk for MS in LATAM (range 1,5-30)
• Prevelence and incidence increase with new studies
• Similar phenotypes
• Similar severity
Conclusions
www.esclerosismultiple.org