Introduction: Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system and the leading cause of non-traumatic disability in young adults. Disease-modifying therapies (DMTs) have transformed its management, reducing relapses and delaying progression, with over fifteen options approved worldwide. However, access to DMTs in Ecuador began only in 2008, with limited data available on their impact on adherence and therapeutic persistence. This study aims to describe the experience with disease-modifying agents in a tertiary-level care unit.
Methods: A retrospective study was conducted involving 142 MS patients treated at a tertiary hospital in Ecuador who met the McDonald 2017 diagnostic criteria and received DMTs between 1995 and 2022. Patients who left the country or social security system were excluded. Demographic and clinical data (EDSS), disease chronology, therapeutic lines, and treatment changes were analyzed. Statistical analysis was performed using SPSS.
Results: The study population consisted of MS patients evaluated at a tertiary hospital in Quito, Ecuador. Among them, 30.3% were male an 69.7% female. The average time between diagnosis and treatment initiation showed a progressive decrease, from 59.3 months for Betaferon to 4.2 months for Rituximab, reflecting improvements in access to DMTs and an improvement in the diagnostic criteria. Regarding the first-line treatment, interferons predominated during earlier periods, while advanced therapies such as Fingolimod, Rituximab, Ocrelizumab and Cladribine gained relevance after 2016. A total of 59% of patients changed treatment, primarily due to therapeutic failure. In the second line, Fingolimod (28.92%) and Rituximab (17.9%) were the most frequently used, although 53.6% of patients required another change. In third- and fourth-line treatments, the use of high-efficacy therapies increased, with Rituximab and Ocrelizumab being prominent. Final treatment data showed that Rituximab (30.3%) was the most commonly used therapy, followed by Rebif (21.8%) and Fingolimod (17.6%). Overall, 41.5% of patients received high-efficacy therapies, while interferons accounted for 36% of treatments. These findings highlight a transition toward more effective and personalized therapies in the management of MS in Ecuador.
Conclusions: This study demonstrates the evolving use of DMTs in MS treatment un Ecuador. It was evident that prior to 2005, there was no access to DMTs. Throughout the study period, interferons were the most widely used drugs but also had the highest rates of therapeutic failure. Adherence and tolerability improved with the introduction of high-efficacy drugs such as Fingolimod, cladribine, Ocrelizumab and Rituximab. Treatment initiation times were notably shortened, primarily due to advancements in diagnostic criteria and improved meditation access.
