Abstract Details

Title A Global Atlas of NMO Diagnosis and Treatment Practices

Topic Multiple Sclerosis

Presentation(s) P1 - Poster Session 1 (5:30 PM-6:30 PM)

Poster/Presentation
Number 15-074

Objective To perform a comprehensive assessment of the availability, accessibility, and affordability of NMO diagnosis and treatment globally, with a focus on low- and middle-income countries

Background NMO represents a distinct clinical and pathogenic entity for which a standard of care in diagnosis and treatment has emerged in the past two decades.

Design/Methods A structured survey was developed and piloted by a team of neurologists and survey designers, using an online platform, targeted to physicians who would encounter patients with NMO. Physicians were invited in English and Spanish, from July-October 2018, with the option to receive a translation to any major language and an honorarium.

Results

Respondents from 52 of 143 countries contacted responded in full (response rate: 36%) including 10 low-, 14 lower middle-, 15 upper middle-, and 13 high-income countries with good representation across geographic regions. Eight respondents (15%) reported limited familiarity with NMO, while the remaining 44 (85%) reported treating NMO patients (mean patient volume of respondents 10-15 NMO patients/year). Access to the aquaporin-4 antibody was 67% and access to MOG antibody was 37%. The median cost of the aquaporin-4 antibody test was $63 in low-, $165 in lower middle-, $95 in upper middle-, and $64 in upper-income countries. 87% of physicians had access to azathioprine, 52% to rituximab, and 56% to mycophenolate mofetil. The most commonly reported barriers to NMO treatment were out of pocket costs to patients and inconsistent supply of medications.

Conclusions There remains a primary need to diagnose NMO based on antibody testing in one third of reporting countries. Azathioprine remains a drug of choice in many locations due to cost. Targeted programs are required to improve awareness of NMO in countries where it is likely more prevalent, increase access and affordability of the main diagnostic test, and develop guidelines on treatment for populations with limited drug availability.

Authors/Disclosures
Kathryn Holroyd, MD PRESENTER	The institution of Dr. Holroyd has received research support from NINDS.
Andre Vogel (Massachusetts General Hospital)	No disclosure on file
Kat Lynch	No disclosure on file
Brittany Gazdag	Brittany Gazdag has received personal compensation for serving as an employee of Praxis Precision Medicines . Brittany Gazdag has stock in Praxis Precision Medicines .
	No disclosure on file
	No disclosure on file
Horacio Chiong-Rivero, MD	Dr. Chiong-Rivero has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Novartis. Dr. Chiong-Rivero has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Biogen. Dr. Chiong-Rivero has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for TG Therapeutics. Dr. Chiong-Rivero has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Amgen. Dr. Chiong-Rivero has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Vanda. An immediate family member of Dr. Chiong-Rivero has received personal compensation in the range of $50,000-$99,999 for serving as a Web content designer with Massachusetts Office of Inspector General.
Farrah J. Mateen, MD, PhD, FAAN (Northwestern University Department of Neurology)	Dr. Mateen has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Amgen. Dr. Mateen has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. Dr. Mateen has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. The institution of Dr. Mateen has received research support from Genentech. The institution of Dr. Mateen has received research support from Amgen. The institution of Dr. Mateen has received research support from TG Therapeutics. Dr. Mateen has received intellectual property interests from a discovery or technology relating to health care.

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