Multiple Sclerosis: Changes in Epidemiology and Gaps in Patient Access

An update to the Atlas of Multiple Sclerosis (MS) shows a modest increase in the number of patients with MS and the prevalence of MS between 2008 and 2013. The report also highlights disparities in access to treatment between high- and low-income countries.

The Multiple Sclerosis International Federation (MSIF) updated a 2008 epidemiologic report on MS with publication of the 2013 Atlas of MS on October 2. The update provides the latest statistics on the epidemiology of MS, patient access to neurologists, and the availability of treatments around the world.

Between 2008 and 2013, the number of people with MS increased from 2.1 million to 2.3 million and the median worldwide prevalence of cases increased from 30 to 33 per 100,000 people. Over the same period, the number of neurologists increased 30% from 1.01 to 1.32 neurologists per 100,000 people. Despite this increase in the number of neurologists, inequalities remain. High-income countries have approximately 100 times as many neurologists per person as do low-income countries.

Regional differences in the prevalence of MS may partially explain the relative lack of availability of expert neurologists in some countries, as the prevalence of MS varies by latitude, with higher prevalence in countries farther from the equator than in countries closer to the equator. Demonstrating this difference, North America has the highest prevalence of MS at 140 cases per 100,000 people compared with 2.1 cases per 100,000 people in sub-Saharan Africa, where the incidence of MS is lowest.

In addition to inequalities in provider access between countries, the 2013 Atlas of MS found variations in access to therapies including natalizumab, fingolimod, and platform therapies such as interferons and glatiramer acetate. Among high-income countries, 76% of them offered subsidized access to fingolimod, 82% offered subsidized access to natalizumab, and 96% offered subsidized access to platform therapies. None of the low-income countries in the survey offered subsidized access to any of these therapies.

The 2013 Atlas of MS shows an adequate number of neurologists worldwide, but an inadequate distribution of neurologists to serve patients in low-income countries. The recent statistics also indicate inadequate access to treatments and a lack of subsidies to offset the cost of therapies among patients in low-income countries. Even in some high-income countries, access to advanced therapies such as fingolimod and natalizumab is incomplete. The MSIF report indicates a need for improved access to therapies, and a more equitable distribution of neurologists around the world.