Therapeutic armamentarium and health system coverage of multiple sclerosis in Latin America.

fer significant support to the different groups of patients and their families and 60% have a multiple sclerosis center/clinic. Only half of the countries have their own formal guidelines to unify the therapeutic approach from a methodological standpoint. There are few collaborative studies, whether national or Epidemiological studies on multiple sclerosis in Latin America have been increasing over the last decade, promoted and encouraged by the Latin American Committee for Treatment and Research in Multiple Sclerosis (LACTRIMS) and societies or academic groups in each particular country. Although they present some methodological differences, recent publications and personal communications begin to provide a reasonable estimate of its frequency as well as some of its features. Prevalence seems to range between 0.75 and 30 per 100,000 inhabitants. The incidence is between 0.6 and 2.2 per 100,000 inhabitants, which in general terms can be regarded as a lowprevalence disease [1–6] . There is scarce information on treatment availability, coverage and therapeutic effectiveness, treatment guides, the existence of academic, patients’ and family associations, participation in clinical trials and national and international collaborative research projects or the disease burden. During a regional meeting on multiple sclerosis held in Cartagena, Colombia on May 20–21, 2011, and the Latin American Workshop on the Consensus for the Management of Multiple Sclerosis held in Quito, Ecuador on July 8–9, 2011, a voluntary survey was applied using a structural questionnaire (treatment availability and coverage; guides; academic, patients’ and family associations; clinical trials and research projects) to some participating neurologists involved in multiple sclerosis and LACTRIMS delegates, considered opinion leaders in multiple sclerosis in their respective countries in order to obtain the information. Twenty countries were included ( table 1 ). This data, although unofficial, gives an idea of the general situation of multiple sclerosis in Latin America. Analyses of the absolute and relative frequencies (percentages) were obtained. We concluded that significant advances have been made in the availability of drugs for treating acute crisis and the use of immunomodulators for relapsing/remitting multiple sclerosis; however, the population’s access to these treatments is below 35% in half of the countries. Among the countries that have the newest drugs available, only 4 have oral treatment with fingolimod and 11 with natalizumab. However, in more than 90% of the countries azathioprine, cyclophosphamide and mitoxantrone are available. On the other hand, all countries have founded associations that ofReceived: November 1, 2011 Accepted: February 10, 2012 Published online: April 27, 2012