Tratamiento de la esclerosis múltiple: situación a octubre del 2020 en los hospitales públicos de Costa Rica

Abstract

Introduction

In recent years, multiple treatments for multiple sclerosis have emerged for both, injectable and oral routes of administration. Most of these medications are currently available in Costa Rica. However, interferons are still the only available treatment in the public health system. An overwhelming administrative procedure is required to justify the purchase of the rest of the options in case they are needed for any specific patient.

Objective

To describe the treatment of multiple sclerosis in Costa Rica.

Patients and methods

A longitudinal, observational and retrospective study of cases with the diagnosis of multiple sclerosis in the Costa Rican public hospital system was carried out between 1990 and December 2017. Drug treatment as of October 2020 was analyzed for those patients who met the 2010 McDonald's criteria.

Results

A total of 448 cases were obtained, of which 437 were under drug treatment. The most frequent used drugs were Interferón β1-a intramuscular (53.6%), Interferón β1-b (21.2%) and Interferón β1-a subcutaneous (7.9%). By 2020, 163 patients (36.4%) had continued with the first medication, meanwhile 274 persons (62.3%) needed a change of drug. Treatment failure was the main cause of change and fingolimod was the main alternative choice. Interferón β1-a intramuscular has a longer time of use and less change rate, while fingolimod and Interferón β1-a subcutaneous are more likely to require change in a shorter period of time.

Conclusion

In Costa Rica, interferons are the most widely used treatments for multiple sclerosis in the public health system. Therapeutic failure is the main reason for changing medication, while fingolimod is the treatment of choice in most cases.