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

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