The burden of multiple sclerosis in China: A literature review

Background & Objective: Multiple sclerosis is a relatively rare disease in China as compared to other nations throughout the world. This study aimed to assess the depth and breadth of knowledge of multiple sclerosis and its consequences specifi cally in China via a review and synthesis of existing literature. Methods: We conducted a literature search and reviewed studies that either were published in MEDLINE-indexed, English-language journals, or China National Knowledge Infrastructure databaseindexed, Chongqing VIP Information Co., Ltd database-indexed, or Wanfang Data database-indexed Chinese-language journals, or appeared in the grey literature including medical society websites and scientifi c meeting abstracts from 2005−2010. Results: The only study reporting epidemiological burden reported a prevalence rate of multiple sclerosis to be 1.39 per 100,000 persons. Multiple sclerosis was more prevalent among females as compared to males. Most of the studies used Poser criteria to diagnose multiple sclerosis. Corticosteroids were the mainstay used by physicians for the treatment of multiple sclerosis. Little data is available on epidemiological burden and no data is available on the economic and humanistic burden of multiple sclerosis in China. Conclusions: Diagnostic practices and treatment of multiple sclerosis in China appear to lag behind those in Western countries. There is signifi cant room for improvement in bettering those suffering from multiple sclerosis in China. Neurology Asia 2011; 16(3) : 187 – 193 Address correspondence to: Feng Pan, PhD, United BioSource Corporation, 7101 Wisconsin Avenue, Suite 600, Bethesda, MD 20814, USA. Phone: +1-240-235-2511, Fax: +1-301-654-9864, e-mail: [email protected] INTRODUCTION Multiple sclerosis (MS) is a chronic disease that attacks the central nervous system, particularly the brain, spinal cord, and optic nerves. MS is a debilitating disease with a signifi cant deleterious effect on patients’ quality of life and work productivity. MS is a relatively rare disease in China as compared to other nations throughout the world. The World Health Organization estimates that the median prevalence of MS in the Western Pacifi c region, which includes China, was 5 cases per 100,000 persons between 2005 and 2007. Median incidence was found to be 0.9 per 100,000 persons. By comparison, median prevalence in Europe over the same period was 80 cases per 100,000 people and median incidence was 3.8 per 100,000 persons. Clinically, multiple sets of criteria for diagnosing MS exist. One early method of diagnosis, known as the Poser criteria, was introduced in 1983. The Poser criteria relied on various combinations of symptoms, patient history, lesions of the central nervous system, and cerebrospinal fl uid (CSF) abnormalities to classify MS. In 2000, McDonald et al. proposed new and improved diagnostic criteria that incorporate magnetic resonance imaging (MRI) and visual evoked potentials in addition to analysis of CSF. Simplifying, evidence-based revisions to the McDonald criteria were made in 2005. Chong et al. proposed modifi cations to the McDonald criteria for Asians with MS to increase the sensitivity and specifi city of the McDonald criteria in this population, focusing mainly on differences in clinical presentations between Asian MS patients and Western MS patients. Treatments for MS also vary. Diseasemodifying therapies (DMTs) are commonly used for the treatment of MS in Western countries. DMTs have the capacity to alter the course of disease as well as treat symptoms. Common Neurology Asia September 2011 188 DMTs include interferon beta (IFNβ)-1a (Rebif), IFNβ-1b (Betaseron), and IFNβ-1a (Avonex), glatiramer acetate (Copaxone), mitoxantrone (Novantrone), and natalizumab (Tysabri). Corticosteroids are also used to treat MS. Corticosteroids shorten the duration of relapse but do not alter the course of the disease. With the availability of DMTs, corticosteroids are now rarely used in Western countries. The prevalence and impact of MS, methods of diagnosis, and available treatments are well characterized in Western countries where incidence and prevalence of the disease is relatively high, yet are not as well known in other countries, such as China. This study aimed to assess the depth and breadth of knowledge of MS and its consequences specifi cally in China via a review and synthesis of existing literature. The primary intent was to elucidate the epidemiological, economic, and humanistic burden of MS in China. The secondary aim was to classify methods of diagnosis and treatment patterns of the disease unique to China. METHODS In order to meet the primary and secondary aims of this study, a literature search was conducted using MEDLINE as well as Chinaspecifi c databases provided by China National Knowledge Infrastructure (CNKI), Chongqing VIP Information Co., Ltd. (CQVIP), and Wanfang Data. The searches in MEDLINE were limited to English-language literature, while the searches in all databases were limited to articles on human subjects published between 1 January 2005 and 3 March 2010. Literature search term strings to best address each study aim were created and are shown in Table 1. Abstracts of each article identifi ed in the search were manually reviewed by study investigators to assess potential inclusion in the review. In accordance with the primary and secondary study aims, articles were included if they reported epidemiology data, humanistic outcomes, economic outcomes, or diagnostic and treatment patterns of MS that were unique to China. To augment searches performed in the databases above, “grey literature” was also Table 1: Search strategy Search Variable Search Strategy Epidemiology “Multiple Sclerosis” and (epidemiol* or incidence or prevalence or risk factor*) and (China or Chinese) Diagnostic patterns “Multiple Sclerosis” and (present or presents or presentation or presenting or diagnos* or screen*) and (China or Chinese) Treatment patterns “Multiple Sclerosis” and (treatment* or therap* or pharmaceutical* or drug or drugs or medicine* or surger* or surgical or medication*) and (management or pattern* or use or prescribing or trend* or survey or database) and (China or Chinese) Clinical outcomes, including “Multiple Sclerosis” and (progress* or prognos* or survival or natural history/progression of mortality or “natural history”) and (China or Chinese) disease and treatment outcomes Humanistic outcomes “Multiple Sclerosis” and (“quality of life” or “quality-of-life” or “patient reported outcome” or “patient-reported outcome” or “patient reported outcomes” or “patient-reported outcomes” or satisfaction or utility or disability or “functional status” or “physical function”) and (China or Chinese) Economic outcomes “Multiple Sclerosis” and (cost or costs or budget* or expenditure* or resource utiliz* or economic* or pharmacoeconomic* or disab* or productiv* or (loss and work)) and (China or Chinese)