在伊拉克,缺乏基于证据的诊断管理协议,治疗,和管理多发性硬化症(MS)会带来不良结局和临床实践变异性的风险以及对患者的潜在伤害。这项研究旨在就伊拉克MS的诊断和管理提出共识建议,特别关注初治患者,次优响应者,和孕前育龄妇女,怀孕计划,和泌乳。进行了一项调查,以收集来自十个主要意见领袖(KOL)的小组的反馈意见,他们评估并讨论了这些声明,以确定协议级别。采用微型德尔菲法对管理建议达成共识,并举行了一次会议,以分析答复,并确保建议基于当前证据,并遵循共识驱动的方法。建议将修订的麦当劳标准用于MS诊断,其中包括疾病特征在空间和时间上传播的证据。疾病活动和进展可以使用复发监测,MRI活动,和短期残疾进展。专家建议在诊断时使用更高效的药物开始治疗,比如克拉屈滨,奥克瑞珠单抗,那他珠单抗,或者利妥昔单抗,对于疾病活动性高的患者,经过仔细的风险分层。可注射干扰素制剂具有可耐受的风险特征,但有缺点,例如给药的途径和频率。总的来说,疾病改良疗法(DMT)已显示出降低复发率和短期残疾的功效.本文提出了专家小组对管理伊拉克MS的建议,考虑到国际准则,药物更新,和当地资源。然而,关于真实世界中使用疾病改善疗法(DMT)的实际问题仍然存在.根据疾病严重程度进行个性化治疗,预后,和个人风险因素,同时坚持指导方针是至关重要的。医疗保健提供者和患者之间的协作方法,考虑到个人偏好,对于实现治疗目标至关重要。
UNASSIGNED: In Iraq, a lack of evidence-based management protocols for diagnosing, treating, and managing multiple sclerosis (MS) poses risks of suboptimal outcomes and clinical practice variability and potential harm to the patients. This study aimed to develop
consensus recommendations regarding the diagnosis and management of MS in Iraq, specifically focusing on treatment-naïve patients, suboptimal responders, and
women of childbearing age during preconception, pregnancy planning, and lactation.
A survey was conducted to collect feedback from a panel of ten key opinion leaders (KOLs), who evaluated and discussed the statements to determine agreement levels. The mini-Delphi method was employed to establish a
consensus on the management recommendations, and a meeting was held to analyze the responses and ensure that the recommendations were based on current evidence and followed a consensus-driven approach.
UNASSIGNED: The Revised McDonald Criteria is recommended for MS diagnosis, which includes evidence of dissemination of disease characteristics in space and time. Disease activity and progression can be monitored using relapses, MRI activity, and short-term disability progression. Experts suggest initiating treatment at diagnosis using higher efficacy medications, such as cladribine, ocrelizumab, natalizumab, or rituximab, for patients with high disease activity after careful risk stratification. Injectable interferon preparations have a tolerable risk profile but have drawbacks, such as the route and frequency of administration. Overall, disease-modifying therapies (DMTs) have shown efficacy in reducing relapse rates and short-term disability.
UNASSIGNED: This article presents expert panel recommendations for managing MS in Iraq, taking into account international
guidelines, medication updates, and local resources. However, practical questions remain regarding the real-world use of disease-modifying therapies (DMTs). Personalizing treatment based on disease severity, prognosis, and individual risk factors while adhering to
guidelines is crucial. A collaborative approach between healthcare providers and patients, considering individual preferences, is vital for achieving treatment goals.