How accessible are MS treatments in the MENA region?

The Middle East and North Africa (MENA) region is a large, diverse region comprising more than 20 countries. It has recorded an increasing prevalence of MS over the past decades, but the management of MS varies considerably between countries due to the availability, accessibility and affordability of disease-modifying therapies (DMTs).

Oumaima from Morocco shares her personal experience of challenges in accessing DMTs – you can read her full story here.

‘The main challenge for us in Morocco is a financial challenge. My treatment cost varies but it is often between 6,000 MAD ($550) and 7,000 MAD ($640) and I have four doses a year. In order to be able to afford the cost of this treatment, we are forced to deprive ourselves of our basic daily needs. There are still efforts that need to be made in the field of disseminating knowledge regarding this disease and in the field of access to affordable treatment. The treatment is now available, but at an exorbitant cost.’

Dr Maya Zeineddine, an MS Specialist from Lebanon, led an in-depth analysis of the MENA region Atlas of MS data, focusing on accessibility to originator, follow-on (generic or biosimilar treatments) and off-label DMTs in each country as well as barriers to MS treatment. The findings have now been published in the journal Multiple Sclerosis and Related Disorders.

Key findings from the 16 MENA countries included in the study were:

• DMTs, including high-efficacy DMTs, are used in most MENA countries.
• Off-label use is common, with 13 out of 16 countries reporting using off-label DMTs to treat MS, in particular azathioprine and rituximab.
• Follow-on DMTs were approved for use by 50% of the countries.
• Cost of treatment was the most important barrier to access, reported in nearly half of the MENA countries.
• More than half of the countries reported problems with treatment continuation, such as irregular supply of medicines.

Access to DMTs across the MENA region has improved over time due to multiple factors, including the availability of specialised MS neurologists, multidisciplinary MS Centres, the foundation of MENACTRIMS (the Middle East North Africa Committee for Treatment and Research in MS), the publication of regional treatment guidelines, and the establishment of the MENACTRIMS registry.

However, there are significant differences across the region. High-income countries such as Kuwait, Oman, Saudi Arabia, UAE and Qatar have access to most DMTs, while the therapeutic options in LMICs such as Tunisia, Algeria, Syria, Iraq and Sudan are more limited, especially for high efficacy DMTs. This variation is likely due to the considerable disparities in socioeconomic status across countries of the MENA region.

There is a need for a targeted regional strategy to address these disparities in access to MS treatments. The development of policies or plans, that can ensure the complex needs of people with neurological disorders are addressed within the context of a particular country or region, is an important objective of the WHO’s intersectoral global action plan for neurology.  This plan, which aims to improve the lives of people living with neurological conditions including MS, covers comprehensive care across the life course and was developed with input from MSIF, its members and the wider movement.

Dr Maya Zeineddine, the lead author of the publication says:

‘Data and evidence are essential to support the development of a comprehensive strategy for MS care in MENA countries, which puts people with MS at the centre. Local MS patients’ societies also have a key role to play, providing services such as programmes or resources to help people affected by MS to navigate the complexity of accessing DMTs.’

This publication resulted from a collaboration between members of MENACTRIMS and MSIF. Please note that it was based on data reported to the Atlas of MS in 2019/2020 so may not reflect the current situation in 2023.

You can also read an editorial by Yeh et al. in MSARD commenting on the findings of this study: Can we improve outcomes in MS around the world? Access and global considerations across income strata

Data from the Atlas of MS is freely available to everyone. If you are interested in analysing data on a particular topic or specific to your region, then we encourage you to do so. Please get in touch with Rachel or Anne at atlas@msif.org if you’d like to discuss your ideas.

Find out more about how access to MS healthcare varies around the world in our Clinical Management report, and access data about your own country through the Atlas of MS website.

You may also be interested in this case study about access to treatment in Egypt. Dr Mai Sharway and Prof Magd Zakaria present a case study from Egypt in this video. Egypt is a lower middle income country but a range of DMTs (interferon, teriflunomide, dimethyl fumarate, fingolimod, cladribine, natalizumab and ocrelizumab) are available and reimbursed by the health system. They give a detailed and practical overview of the advocacy and awareness raising work MS Care in Egypt have done alongside healthcare professionals, in order to achieve access to treatment for people with MS.

Visit our access and advocacy website for more information about improving access to treatment.