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Actualidades en EM

Introducing iWiMS

Industry patient organisation round table summary - ECTRIMS 2019


2019 Neurol Ther biosimilars

Proyecto SROI-EM Impacto clínico, asistencial, económico y social del abordaje ideal de la ESCLEROSIS MÚLTIPLE en comparación con el abordaje actual

Abstracts presentados el LACTRIMS 2018 - Paraguay

Here are the key points related to the EML and our application

Anne Helme

Access to treatment and healthcare

Benjamin Davis MS Society of Canada MSIF International Work Group on Access

Access and barriers to MS care in Latin America

Víctor M Rivera and Miguel Angel Macias


Regina Maria Papais-Alvarenga, Claudia Cristina Ferreira Vasconcelos, Adriana Carra, Ibis Soto de Castillo, Sara Florentin, Fernando Hamuy Diaz de Bedoya, Raul Mandler, Luiza Campanella de Siervi, Maria Lúcia Vellutini Pimente, Marina Papais Alvarenga, Marcos Papais Alvarenga, Anderson Kuntz Grzesiuk, Ana Beatriz Calmon Gama Pereira, Antonio Pereira Gomes Neto, Carolina Velasquez, Carlos Soublette, Cynthia Veronica Fleitas, Denise Sisteroli Diniz, Elizabeth Armas, Elizabeth Batista, Freda Hernandez, Fernanda Ferreira Chaves da Costa Pereira, Heloise Helena Siqueira, Hideraldo Cabeça, Jose Sanchez, Joseph Bruno Bidin Brooks, Marcus Vinicius Gonçalves, Maria Cristina Del Negro Barroso, Maria Elena Ravelo, Maria Carlota Castillo, Maria Lúcia Brito Ferreira, Maria Sheila Guimarães Rocha, Monica Koncke Fiuza Parolin, Omaira Molina, Patricia Beatriz Christino Marinho, Paulo Pereira Christo, Renata Brant de Souza, Silvio Pessanha Neto, Solange Maria das Graças Camargo, Suzana Costa Machado, Vanderson Carvalho Neri, Yara Dadalti Fragoso, Helcio Alvarenga, Luiz Claudio Santos Thuler

Consenso Terapeutico LACTRIMS

Patricio Abad, Jorge Nogales-Gaete, Víctor Rivera, Edgardo Cristiano, Fernando Hamuy, Carlos Oehninger, Regina M.P. Alvarenga, Silvia Tenembaum; en representación del Grupo de Estudio de Esclerosis Múltiple de Latinoamérica (LACTRIMS)


Carlos Oehninger Gatti

EM,Tto en LA

A. Carrá a, V. Rivera-Olmos b, R. Arcega c, A. Gabbai d, S.R. Haussen e, G. Luetic f, E. San Pedro g, S. Tenembaum

Guia Terapeutica ECTRIMS MS

Xavier Montalban, Ralf Gold, Alan J Thompson, Susana Otero-Romero, Maria Pia Amato, Dhia Chandraratna, Michel Clanet, Giancarlo Comi, Tobias Derfuss, Franz Fazekas, Hans Peter Hartung, Eva Havrdova, Bernhard Hemmer, Ludwig Kappos, Roland Liblau, Catherine Lubetzki, Elena Marcus, David H Miller, Tomas Olsson, Steve Pilling, Krysztof Selmaj, Axel Siva, Per Soelberg Sorensen, Maria Pia Sormani, Christoph Thalheim, Heinz Wiendl and Frauke Zipp

Latam Genetics

Victor M. Rivera


Victor M. Rivera


Victor M Rivera

SINOPSIS Estudio de prevalencia de esclerosis multiple en el perú

The genetics of multiple sclerosis in Latin America

Verónica Rivas Alonso, José de Jesú s Flores Rivera, Yamel Rito García and Teresa Corona

The impact of diagnostic criteria for neuromyelitis optica in patients (2)

Regina M Papais-Alvarenga, Claudia CF Vasconcelos, Soniza V Alves- Leon, Elizabeth Batista, Claudia MM Santos, Solange MGG Camargo, Mauricio Godoy, Maria C Lacativa, Mariangela Lorenti, Benito Damasceno, Alfredo Damasceno, Doralina Brum, Amilton A Barreira, Maria S Guimarães Rocha, Helcio Alvarenga and Charles P Tilbery

Multiple sclerosis care in Latin America

Victor M. Rivera, Marco Tulio Medina, Reyna M. Duron, et al.Neurology 2014;82;1660-1661


Before the advent of diagnostic criteria for multiple sclerosis (MS), it was reported that the prevalence of MS in Mexico was “one of the lowest in the world” (1.6/100,000).1 The notion that MS was a rare neurologic disease among those living in the tropics of the Americas and Southern latitudes was widely accepted. The geopolitical boundaries of the region identified as Latin America (LA).

Esclerosis Múltiple y Neuromielitis óptica en Latinoamérica

Retos y oportunidades

Ontaneda D, Correale J. The challenges and opportunities of multiple sclerosis care in Latin America. Mult Scler J Exp Transl Clin. 2017 Sep 25; 3(3): 2055217317720845. doi: 10.1177/2055217317720845. eCollection 2017 Jul-Sep. PubMed PMID: 28979792; PubMed Central PMCID: PMC5617094.

Latin America (LATAM) is a large region spanning North, Central, and South America, between latitudes 32°N and 56°S. The population of LATAM currently estimated at 625 million is predicted to grow to 779 million by 2050.1 LATAM is a genetically, ethnically, geographically, linguistically, economically, and racially diverse region, with an admixture of Amerindian, European, Asian, and African ancestry. Multiple sclerosis (MS) was long considered a relatively rare entity in the region, but research over the past 10 years, and increased availability of magnetic resonance imaging (MRI) scanners have demonstrated that MS does occur in almost all Latin American countries, including those close to the equator, although with marked differences in prevalence and incidence between countries.2


Cristiano E, Rojas JI. Multiple sclerosis epidemiology in Latin America: An updated survey. Mult Scler J Exp Transl Clin. 2017 Jun 13; 3(2):2055217317715050. doi: 10.1177/2055217317715050. eCollection 2017 Apr-Jun. PubMed PMID: 28638628; PubMed Central PMCID: PMC5472231.

Systematic study of multiple sclerosis (MS) in populations started in 1929 when 40 cases in North Wales were ascertained, estimating a point prevalence of 13 per 100,000 inhabitants.1 Today, there are several publications that deal with prevalence and incidence of MS throughout the world; nonetheless, despite this wealth of data, current knowledge of MS epidemiology in Latin America (LATAM) is limited.2-5

Amezcua L, Oksenberg JR, McCauley JL. MS in self-identified Hispanic/Latino individuals living in the US. Mult Scler J Exp Transl Clin. 2017 Sep 25; 3(3):2055217317725103. doi:10.1177/2055217317725103. eCollection 2017 Jul-Sep. Review. PubMed PMID: 28979795; PubMed Central PMCID: PMC5617095.

Multiple sclerosis (MS) is an immune-mediated, progressive, demyelinating, and degenerative disease. Well-documented differences in disease prevalence, age of onset, central nervous system site of injury, and progression have been observed across ancestral groups and are thought to be in part, the result of a complex interaction between genetic risk factors, lifestyle, and environmental exposures. In the United States (US), it is estimated that the number of Hispanics with MS will increase, given the estimates that the proportion of Hispanics in the US population will rise from 14% in 2005 to 29% by 2050 (web 1). Despite these numbers, Hispanics with MS in the US remain an understudied population.1

Epidemiología de NMO

Alvarenga MP, Schimidt S, Alvarenga RP. Epidemiology of neuromyelitis óptica in Latin America. Mult Scler J Exp Transl Clin. 2017 Sep 25; 3(3):2055217317730098. doi: 10.1177/2055217317730098. eCollection 2017 Jul-Sep. Review. PubMed PMID: 28979797; PubMed Central PMCID: PMC5617096.

In 1894, Euge`ne Devic, a French physician, while attending a medical meeting in Lyon, described a clinical pathological case of ‘‘acute neuromyelitis optica’’ (NMO) in a woman who developed paraplegia followed by a bilateral amaurosis with fatal course.1 Since this report, NMO is also known as Devic’s disease.2

Factores ambientales

Correale J, Farez MF, Gaitán MI. Environmental factors influencing multiple sclerosis in Latin America. Mult Scler J Exp Transl Clin. 2017 Jun 13; 3(2):2055217317715049. doi: 10.1177/2055217317715049. eCollection 2017 Apr-Jun. PubMed PMID: 28638627; PubMed Central PMCID: PMC5472234.

Pathogenic mechanisms underlying multiple sclerosis (MS) development have yet to be clearly identified, but considerable evidence indicates autoimmunity plays an important role in MS etiology.1 It is generally accepted that autoimmune diseases like MS arise from complex interactions between individual genetic susceptibility and environmental factors. In Caucasian populations, the strongest genetic link to MS has been found in MHC haplotypes, especially those containing HLA-DRB1*15.01, HLA DQB1*06.02, and DQA1*01.02. Genome-wide association studies have identified more than 100 non-HLA genetic risk loci, many acting as cooperative networks. owever, each of these individual loci exerts modest influence on MS risk, and MHC remains the key susceptibility locus.2


Rivas Alonso V, Flores Rivera JJ, Rito García Y, Corona T. The genetics of multiple sclerosis in Latin America. Mult Scler J Exp Transl Clin. 2017 Sep 25; 3(3):2055217317727295. doi: 10.1177/2055217317727295. eCollection 2017 Jul-Sep. Review. PubMed PMID: 28979796; PubMed Central PMCID: PMC5617105.

In today’s globalised world, cultural diversity and genetics are permanently being studied. There is repeated mention of the influence of environmental factors and population-based genetic susceptibility, cultural-genetic pluralism and multiculturalism, hybrid populations and their influence on the heterogeneity of diseases such as multiple sclerosis (MS). The first cultures on the American continent appeared approximately 45,000 years ago and belonged to a nomadic group of hunter-gatherers who migrated from north to south in successive waves. They originated in the Asiatic steppes before crossing the Bering Strait. The unity of the human species is a scientifically irrefutable fact and American regions were populated over tens of thousands of years, as were other parts of the world, starting from a common origin that is possibly located in Africa.

Diagnóstico diferencial

Fragoso YD, Elso FG, Carrá A. Differential diagnosis of multiple sclerosis in Latin America. Mult Scler J Exp Transl Clin. 2017 Sep 25; 3(3):2055217317714279. doi: 10.1177/2055217317714279. eCollection 2017 Jul-Sep. Review. PubMed PMID: 28979790; PubMed Central PMCID: PMC5617098.

Correctly diagnosing multiple sclerosis (MS) is achieved through clinical observation, knowledge, correct interpretation of findings from history, examination, imaging and other examinations. Misdiagnosis of MS comes with a burden of psychosocial, economic, personal and professional losses to patients and should be avoided at all costs.1 For diagnosing of MS to be improved, it is important to consider the conditions that are particular to the region of the world where the patient was born and/ or lives. While general overall criteria must be used for diagnosing MS everywhere, awareness of regional differences needs to be kept in mind. Therefore, Latin American patients who are screened for MS may require an approach that differs from what is used in North America, western Europe or Asia.

Tratamientos modificadores de la enfermedad

Rivera VM, Macias MA. Access and barriers to MS care in Latin America. Mult Scler J Exp Transl Clin. 2017 Mar 23; 3(1):2055217317700668. doi:10.1177/2055217317700668. eCollection 2017 Jan-Mar. Review. PubMed PMID:28607755; PubMed Central PMCID: PMC5433222.

The increasing presence of multiple sclerosis (MS) in Latin American (LATAM) causes a complex conglomerate of challenges, including the economic burden exerted by the disease in developing economies. The socioeconomic impact of MS in the Americas constitutes a realistic public health concern in most areas of the continent, despite its relatively low prevalence in the region. While this situation is not exclusive of LATAM (similar concerns have been expressed in other parts of the developing world),1 the increasing cost of MS medications appears to be a global phenomenon driven by industrial price escalation and market tolerance.2 Considering that prices of disease modifying therapies (DMTs) and medications for symptomatic management are the main direct factors determining the costs of MS care, particularly in LATAM, this situation is confounded by the additional gravamen of other tangible and intangible costs (absence from work, rehabilitation, informal caregivers time, etc.) and the existing limitations to provide alleviating services and coverage from public health and national social security institutions (SSIs). Each country in LATAM has different health laws integrated with their own medicines licensing departments and a host of institutional systems for delivery of care. There are substantial disparities in providing quality and efficient care throughout the region. The barriers faced by MS patients and health providers in LATAM in accessing in some cases the minimum of MS management deserve discussion.

Esclerosis Múltiple en Latinoamérica

Factores ambientales

Becker J, Callegaro D, Lana-Peixoto MA, Talim N, Vidaletti T, de Paula Corrêa M, Gomes I. Hypovitaminosis D association with disease activity in relapsing remitting multiple sclerosis in Brazil. J Neurol Sci. 2016 Apr 15;363:236-9. doi:10.1016/j.jns.2016.02.064. Epub 2016 Feb 27. PubMed PMID: 27000256.

Multiple sclerosis (MS) onset is believed to result from a combination of environmental and genetic factors. A prevailing theory addresses the influence of hypovitaminosis D in the development of MS. This research aimed to study the association between vitamin D serum levels and MS, as a prognostic and risk factor for the development and progression of the disease. A cross-sectional multicenter study was conducted in patients with relapsing-remitting MS (n=67), according to the revised McDonald criteria (2010), accompanied in three MS centers in different Brazilian states.


Correa E, Paredes V, Martínez B. Prevalence of multiple sclerosis in Latin America and its relationship with European migration. Mult Scler J Exp Transl Clin. 2016 Sep 2;2:2055217316666407. doi:10.1177/2055217316666407. eCollection 2016 Jan-Dec. Review. PubMed PMID: 28607738; PubMed Central PMCID: PMC5433402.

Multiple sclerosis (MS) is a chronic, degenerative autoimmune inflammatory disease of the central nervous system. The prevalence is different in every continent, changing according to geographical and environmental characteristics. The areas with the highest prevalence in the world are Europe and North America

Gracia F, Parajeles VA, Panday A, Guirado-Romero AE, Molina KB, Treviño-Frenk I. Multiple sclerosis in Central America and the Caribbean: Current status and care recommendations. Rev Mex Neuroci 2018;18.

Background: Multiple Sclerosis (MS) is a very serious, highly debilitating and costly disease. The medical management of MS is complex and in regions and countries with relatively limited health care systems and reduced financial resources, the impact of MS on individuals and society can be alarming. Method: To better understand the issues related to MS management in Central America and the Caribbean, a group of experts from the Region and nearby countries were assembled to assess the status of MS and provide recommendations to government, organizations and practitioners. 

da Gama Pereira AB, Sampaio Lacativa MC, da Costa Pereira FF, Papais Alvarenga RM. Prevalence of multiple sclerosis in Brazil: A systematic review. Mult Scler Relat Disord. 2015 Nov;4(6):572-9. doi:10.1016/j.msard.2015.08.004. Epub 2015 Aug 15. Review. PubMed PMID: 26590664.

Epidemiological studies of multiple sclerosis (MS) conducted in Latin America have revealed prevalence rates of this disease from low to medium. 

Chinea A, Ríos-Bedoya CF, Vicente I, Rubí C, García G, Rivera A, Díaz A,Romero EE, Hernández Silvestrini Y, Díaz Y; Grupo de Estudios Colaborativos de Puerto Rico en Esclerosis Múltiple (GECPREM). Increasing Incidence and Prevalence of Multiple Sclerosis in Puerto Rico (2013-2016). Neuroepidemiology. 2017 Nov 14;49(3-4):106-112. doi: 10.1159/000484090. [Epub ahead of print] PubMed PMID:29136613.

The incidence of multiple sclerosis (MS) has been increasing worldwide over the past decades. However, this upward trend has not been examined at the country level in Latin America and the Caribbean (LAC). The aims of this study are to examine trends of MS incidence over 4 years and to provide age- and gender-standardized incidence rate estimates for a Caribbean island.

Tratamiento modificador de la enfermedad en Latinoamérica

Correale J. Follow-on products for treatment of multiple sclerosis in Latin America: An update. J Neurol Sci. 2017 Oct 15;381:153-159. doi: 10.1016/j.jns.2017.08.3242. Epub 2017 Aug 24. Review. PubMed PMID: 28991670.

Both proprietary and non-proprietary medicines are expected to undergo rigorous pre-approval testing and both should meet stringent health authority regulatory requirements related to quality to obtain approval. Non-proprietary (also known as copy or generic) medicines, which base their authorization and use on the proprietary documentation and label, are often viewed as a means to help lower cost and thus increase patient access

Multiple Sclerosis: Changing Trends in Latin Americans. Epidemiology and Regional Characteristics.

Victor M. Rivera

Multiple Sclerosis (MS) is a multifactorial disease of the central nervous system (CNS) in which environmental factors interact with the immunological milieu of a genetically susceptible individual. MS is considered the second most common cause of neurological disability in the young adult after head trauma (1). Its complex challenges (from diagnosis to management) constitute a realistic public health concern in Latin America (LATAM), where the disease exerts an enormous socioeconomic burden despite its relatively low prevalence, considering the majority of these countries are emergent economies (2).

Esclerosis Múltiple: Manual para pacientes, familiares y cuidadores

Ana Valeria Aguirre Güemez, Brenda Bertado Cortés, Fernando Cortés-Enrí­quez, Enrique Coss Adame, Manuel de la Maza Flores, Daniel Diosdado Carranza, Irene Treviño Frenk, José Flores Rivera, Diana Gaeta Corona, Arturo García Mora, Ví­ctor González Amézquita, Ana Cristina Hernández , Leonardo Llamas-López, Gloria de Lourdes Llamosa, Miguel Ángel Macías Islas, Héctor Rubén Martínez, Fanny Siboney Medina Aguilar, Lilia Núñez Orozco, Laura Ordóñez Boschetti, Alejandra Elena Orozco, Sandra Quiñones Aguilar, Yamel Claudia Rito García, Eli Skromne Eisenberg, Claudia Mayela Torres Romero, Merced Velázquez Quintana, Lucía Ventura Castro

La esclerosis múltiple (EM) es una enfermedad autoinmune que se origina en el sistema nervioso central, el cual está compuesto por el encéfalo (cerebro, tallo cerebral y cerebelo) y la médula espinal. Se manifiesta con inflamación en las fibras nerviosas, lo que conduce a la pérdida gradual de las funciones del cuerpo (neurodegeneración). Esto es debido a que se destruye una capa que protege las prolongaciones de las neuronas llamada mielina. Por este motivo, la EM se considera una enfermedad desmielinizante.

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