Disease modifying treatment guidelines for multiple sclerosis in the United Arab Emirates.

The newly constituted National Multiple Sclerosis (MS) Society (NMSS)of the United Arab Emirates (UAE), set up a scientific committee to create a MS disease modifying treatment (DMT) guideline for UAE. The committee considered several unique features of the MS community in UAE including large number of expatriate population, wide variations in health insurance coverage, physician and patient preferences for DMT. The overall goal of the treatment guideline is to facilitate the most appropriate DMT to the widest number of patients. To this end it has adapted recommendations from various health systems and regulatory authorities into a pragmatic amalgamation of best practices from across the world. Importantly where data is unavailable or controversial, a common sense approach is taken rather than leave physicians and patients in limbo. The committee classifies MS into subcategories and suggests appropriate treatment choices. It recommends treatment of RIS and CIS with poor prognostic factors. It largely equates the efficacy and safety of DMT with similar mechanisms of action or drug classes e.g. ocrelizumab is similar to rituximab. It allows early switching of treatment for unambiguous disease activity and those with progression independent of relapses. Autologous hematopoietic stem cell transplantation can be offered to patients who fail one high efficacy DMT. Pragmatic guidance on switching and stopping DMT, DMT choices in pregnancy, lactation and pediatric MS have been included. It is expected that these guidelines will be updated periodically as new data becomes available.
Competing Interests: Declaration of competing interest Anu Jacob has received advisory board fees and speakers fee from Astra Zeneca. Ahmed Shatila has received speaker's honoraria, advisory board fees, travel grants from Novartis, Sanofi Genzyme, Roche, Merck, Jansen, Biologix, pfizer, Boehringer Ingelheim, AstraZeneca, Lundbeck and Argenx, Bayer, Biogen and received research grants from Novartis, AstraZeneca and Argenx. Jihad Inshasi has received speaker's honoraria from Bayer, Biogen, Biologix, Merck, Novartis, Roche, Sanofi; Research grants from Merck, Novartis; Advisory board fees from Bayer, Biogen,Merck, Novartis, Roche, Sanofi Joelle Massouh has received speakers’ honoraria, travel, grants and advisory board fees from AstraZeneca, Biogen, Biologix, Janssen, Merck, Novartis, Roche, and Sanofi. Ruquia Mir has received speaker's honoraria, advisory board fees and travel grants from Merck Sanofi Novartis Roche Suzan Noori has no disclosures. Bassem Yamout has received speaker's honoraria travel, grants and advisory board fees from Bayer, Biogen, Biologix, Genpharm, Merck, Novartis, Roche, Sanofi, Genzyme and research grants from Bayer, Biogen, Biologix, Merck, Novartis, Pfizer
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