Recommendations for essential medicines for multiple sclerosis in low-resource settings

Saylor D 1 , Rijke N 2 , McDonell J 3 , Laurson-Doube J 2 , Avasarala J 4 , Baldin E 5 Show all authors , Banerjee TK 6 , Bogdanovic I 7 , Bove R 8 , Chawla DK 9 , Costello K 10 , Del Giovane C 11 , Abkari NE 12 , Filippini G 13 , Foschi M 14 , Gonzalez-Lorenzo M 15 , Helme A 2 , Jacobs D 16 , Kalincik T 17 , Mantel-Teeuwisse A 18 , Minozzi S 19 , Navas C 20 , Nonino F 5 , Ojo OO 21 , Ozcan B 22 , Pasi E 23 , Peryer G 24 , Prato Chichiraldi A 25 , Ridley B 5 , Sokhi DS 26 , Traboulsee A 27 , Tramacere I 13 , Tye JS 28 , Vecchi S 19 , Viswanathan S 29 , Xie F 30 , Zeineddine M 31 , Schunemann H 32 , Piggott T 33

Affiliations 

  • 1 Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA; Department of Medicine, University Teaching Hospital, Lusaka, Zambia
  • 2 Multiple Sclerosis International Federation, London, UK
  • 3 MS Canada, Toronto, ON, Canada
  • 4 Department of Neurology, University of Kentucky Medical Center, Lexington, KY, USA
  • 5 IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
  • 6 National Neurosciences Centre Calcutta, Kolkata, India
  • 7 MS Platform Serbia, Belgrade, Serbia
  • 8 UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
  • 9 East West Medical Center, New Delhi, India
  • 10 Can Do Multiple Sclerosis, Avon, CO, USA
  • 11 Department of Medical and Surgical Sciences, University Hospital of Modena and Reggio Emilia, Modena, Italy; Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
  • 12 HANA Multiple Sclerosis Patients Association, Fes, Morocco
  • 13 IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
  • 14 Department of Neuroscience, Multiple Sclerosis Center-Neurology Unit, S. Maria delle Croci Hospital, AUSL Romagna, Ravenna, Italy; Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
  • 15 Laboratorio di Metodologia delle revisioni sistematiche e produzione di Linee Guida, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
  • 16 Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
  • 17 Neuroimmunology Centre, Department of Neurology, The Royal Melbourne Hospital, Melbourne, Australia; CORe (Clinical Outcomes Research unit), Department of Medicine, University of Melbourne, Melbourne, Australia
  • 18 Utrecht Centre for Pharmaceutical Policy and Regulation, Utrecht University, Utrecht, the Netherlands; Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
  • 19 Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
  • 20 Department of Neurology, Hospital San Jose, Clinica Universitaria Colombia, Bogota, Colombia
  • 21 Neurology Unit, Department of Medicine, College of Medicine, Lagos Teaching Hospital, University of Lagos, Lagos, Nigeria
  • 22 Multiple Sclerosis Namibia, Windhoek, Namibia
  • 23 WHO Collaborating Centre in Evidence-Based Research Synthesis and Guideline Development, Bologna, Italy
  • 24 School of Health Sciences, University of East Anglia, Norwich, UK
  • 25 Department of Psychology, Ministerio de Desarrollo Social de Uruguay, Montevideo, Uruguay
  • 26 Department of Neurology, Medical College, The Aga Khan University, Nairobi, Kenya
  • 27 Department of Neurology, The University of British Columbia, Vancouver, BC, Canada
  • 28 National Neuroscience Institute, Singapore, Singapore
  • 29 Department of Neurology, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia
  • 30 Department of Health Research Methods, Evidence and Impact, Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada
  • 31 Inserm U1094, IRD U270, University Limoges, Limoges, France; Institute of Epidemiology and Tropical Neurology, Omega Health, Limoges, France
  • 32 Clinical Epidemiology and Research Center, Humanitas Research Hospital, Humanitas University, Milan, Italy
  • 33 Department of Family Medicine, Queen's University, Kingston, ON, Canada; Peterborough Public Health, Peterborough, ON, Canada
Mult Scler, 2025 Apr;31(4):464-473.
PMID: 40167177 DOI: 10.1177/13524585241308134

Abstract

BACKGROUND: Multiple sclerosis (MS) is a demyelinating disease of the central nervous system that, when untreated, can lead to significant disability in young adults. Despite the increase in the number of disease-modifying therapies (DMTs), many people living with MS in low-resource settings do not have access to treatment.

OBJECTIVE: The primary aim was to develop recommendations on the minimum essential DMTs for MS that should be available in low-resource settings.

METHODS: The Multiple Sclerosis International Federation established an independent, international panel including healthcare professionals and people with MS. This panel, in collaboration with the Cochrane MS Group and McMaster GRADE Centre, reviewed evidence for use of MS DMTs following standardized GRADE protocols including consideration of balance of benefits and harms; certainty of evidence; resources required and cost-effectiveness and values, equity, feasibility and availability in low-resource settings.

RESULTS: For active and/or worsening forms of relapsing MS, the panel recommends use of ocrelizumab, cladribine, fingolimod, dimethyl fumarate, interferon beta and glatiramer acetate. For active and/or worsening forms of progressive MS, the panel recommends use of rituximab, ocrelizumab, glatiramer acetate, fingolimod and interferon beta.

CONCLUSIONS: Recommendations for the minimum essential DMTs for MS in low-resource settings were developed based on robust consideration of evidence and relevant context.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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