BACKGROUND:Published real-world evidence on the direct and indirect costs associated with infused disease-modifying treatments (IV-DMTs) for relapsing-remitting multiple sclerosis (RRMS) remains scarce in Argentina and Latin America. OBJECTIVE:To estimate first-year real-world direct and indirect costs of IV-DMTs [ocrelizumab (OCR), alemtuzumab (ATZ) and natalizumab (NTZ)] in RRMS patients in Argentina. METHODS:We conducted a non-interventional study of adult RRMS patients who initiated IV-DMTs between August 2018 and August 2020. Resource use and costs were collected via an ad hoc questionnaire. Direct and indirect costs were calculated using unit costs in Argentine pesos (December 2022) and converted to US dollars (1 USD = AR$172.9). RESULTS:A total of 125 patients were analysed (mean age 35.9 years; disease duration 8.9 years; EDSS 2.0). The most frequently used IV-DMTs were NTZ (51.2%), OCR (33.6%), and ATZ (15.2%). Total annual costs averaged USD 62,831 ± 14,813 per patient, with the DMT itself accounting for 85% of total costs. By treatment, first-year costs were USD 85,293 for ATZ; USD 56,140 for NTZ; and USD 62,867 for OCR. Costs did not differ by sex or EDSS. CONCLUSION:First-year IV-DMT costs averaged USD 62,831, approximately 4.5 times the Argentine GDP per capita, highlighting the substantial economic burden of these treatments in Argentina.

El trastorno por déficit de atención e hiperactividad (TDAH) ha sido tradicionalmente concebido como una condición privativa de la infancia. Sin embargo, una creciente evidencia sugiere que el TDAH persiste en la vida adulta, manifestándose de diversas maneras. A pesar de su prevalencia y de las significativas consecuencias en la vida cotidiana, el TDAH en adultos ha sido considerablemente subestimado y subdiagnosticado, lo que resulta en una carga sustancial tanto para los individuos afectados como para su entorno familiar y social. Esta revisión exhaustiva se propone explorar la complejidad del TDAH en la adultez y aborda su etiología, definición y presentación clínica, los factores de riesgo, las comorbilidades más frecuentes, los métodos de evaluación y los aspectos neuropsicológicos, así como los enfoques farmacoterapéuticos y los no farmacoterapéuticos para su tratamiento. Además, se examinan las implicaciones para el diagnóstico y el tratamiento, destacando la importancia de una comprensión integral de esta condición. A través de este documento, la Asociación Argentina de Psiquiatría Biológica (AAPB) aspira no solo a recopilar y analizar la evidencia sobre el TDAH en adultos, sino también a proporcionar una guía útil para los profesionales de la salud que tratan esta patología. Así, el objetivo final de este artículo es contribuir al desarrollo de estrategias efectivas para la evaluación y el manejo del TDAH, y mejorar de este modo la calidad de vida de los pacientes.

Attention Deficit Hyperactivity Disorder (ADHD) has traditionally been understood as a condition primarily associated with childhood. However, growing evidence indicates that ADHD persists into adulthood, manifesting in various ways. Despite its prevalence and significant impact on daily life, adult ADHD has been considerably underestimated and underdiagnosed, resulting in a substantial burden for affected individuals, as well as their families and social environment. This comprehensive review aims to explore the complexity of ADHD in adulthood by addressing its etiology, definition, clinical presentation, risk factors, common comorbidities, evaluation methods, and neuropsychological aspects, alongside both pharmacotherapeutic and non-pharmacotherapeutic approaches for treatment. Additionally, the implications for diagnosis and treatment are examined, emphasizing the need for a thorough understanding of this condition. Through this document, the Argentine Association of Biological Psychiatry (Asociación Argentina de Psiquiatría Biológica, AAPB) not only seeks to compile and analyze the evidence on adult ADHD but also to provide a practical guide for healthcare professionals treating this disorder. The ultimate goal of this article is to contribute to the development of effective strategies for the evaluation and management of ADHD, ultimately improving the quality of life for patients.

This document constitutes the second section of the First Argentine Consensus on the management of Attention Deficit Hyperactivity Disorder (ADHD) in adulthood. The focus of this section is the synthesis of updated evidence on comprehensive therapeutic approaches to the condition in adult patients. The methodology described in the first part of the Consensus was followed, with the panel of experts carrying out an exhaustive review of the literature. This was followed by a subsequent debate on the available information, which resulted in the generation of this second section of the document, covering clinical and diagnostic aspects. During the debate and discussion stage of the formulation of these guidelines, it was decided to incorporate some points that are believed to be of great utility for the interdisciplinary team responsible for the management of ADHD patients in adulthood. In this sense, the second part of this document will address the clinical aspects of ADHD in adulthood, diagnostic assessment, neuropsychological profile, comorbidities and differential diagnoses.

This document corresponds to the third and final part of the First Argentine Consensus on the management of attention deficit hyperactivity disorder in adults, focused on summarizing the current evidence on therapeutic approaches to this pathology in adult patients. Following the methodology described in the first and second parts of the Consensus, the panel of experts conducted an exhaustive review of the literature and, as a result of a subsequent debate on the available information, the final part of this document was prepared, covering the comprehensive treatment of adults with this disorder. During the debate and discussion stage, it was decided to structure this final section of the consensus with some points that we believe will be of great use to the interdisciplinary team responsible for managing adult ADHD patients. In this section of the document, you will find general recommendations for pharmacological treatment and the management of adverse effects, comorbidity treatment, non-pharmacological interventions (NPI), as well as the impact of untreated ADHD.

Este documento corresponde a la Segunda Parte del Primer Consenso Argentino sobre el manejo del Trastorno por Déficit de Atención e Hiperactividad en la adultez, en la que se sintetiza la evidencia actualizada sobre los abordajes terapéuticos integrales de esta patología en pacientes adultos. Siguiendo la metodología descrita en la primera parte del consenso, el panel de expertos realizó una exhaustiva revisión de la bibliografía y, tras un debate sobre la información disponible, se generó esta segunda sección del documento, que abarca los aspectos clínicos y diagnósticos. Durante la elaboración de estas guías, se decidió incorporar algunos puntos que estimamos serán de gran utilidad para los equipos interdisciplinares encargados de tratar a pacientes adultos con TDAH. En tal sentido, en la segunda parte de este documento se abordarán los aspectos clínicos del TDAH en la adultez, la evaluación diagnóstica, el perfil neuropsicológico, las comorbilidades y los diagnósticos diferenciales.

Introduction Neuromyelitis optica spectrum disorder (NMOSD) is a serious condition affecting people worldwide, including Latin America (LATAM). Healthcare disparities and economic limitations make effective treatment access challenging. It is crucial to consider the best practice therapeutic decision-making, including emerging long-term preventive therapies, to ensure patients in LATAM and elsewhere can effectively manage their disease all over the world. Objectives/Aims To establish evidence-based guidelines for treatment approaches in NMOSD patients in LATAM. A consensus process was conducted to develop validated statements. Methods A group of NMOSD experts from LATAM utilized a 9-point Likert scale to vote on statements related to NMOSD management. The predetermined consensus threshold was set at a minimum expert agreement of 70%. The RAND/UCLA methodology was employed to reach consensus recommendations. Results Nineteen experts completed the consensus process between March and April 2023. In round 1, no statement failed to reach the predetermined consensus, resulting in 31 agreed statements. The statements were divided between general recommendations (14/31) and clinical scenarios (17/31). The scenarios were based on treatment-naïve NMOSD AQP4 positive patients (4/17); treatment-naive seronegative NMOSD patients (4/17); treatment switching (5/17) and safety (4/17). Conclusions Consensus recommendations were developed on the most important areas of NMOSD treatment by a panel of experts in LATAM. These statements are a valuable tool to guide decision-making and improve patient outcomes, serving as the foundation for developing standardized practice guidelines in our region.

IntroductionThere are no reports in LATAM related to longitudinal humoral and cellular response to adenovirus based COVID-19 vaccines in people with Multiple Sclerosis (pwMS) under different disease modifying therapies (DMTs) and neutralization of the Omicron and Wuhan variants of SARS-COV-2.MethodsIgG anti- SARS-COV-2 spike titer were measured in a cohort of 101 pwMS under fingolimod, dimethyl fumarate, cladribine and antiCD20, as well as 28 healthy controls (HC) were measured 6 weeks after vaccination with 2nd dose (Sputnik V or AZD1222) and 3nd dose (homologous or heterologous schedule). Neutralizing capacity was against Omicron (BA.1) and Wuhan (D614G) variants and pseudotyped particles and Cellular response were analyzed.ResultsMultivariate regression analysis showed anti-cd20 (β= -,349, 95% CI: -3655.6 - -369.01, p=0.017) and fingolimod (β=-,399, 95% CI: -3363.8 - -250.9, p=0.023) treatments as an independent factor associated with low antibody response (r2 adjusted=0.157). After the 2nd dose we found a correlation between total and neutralizing titers against D614G (rho=0.6; p<0.001; slope 0.8, 95%CI:0.4-1.3), with no differences between DMTs. Neutralization capacity was lower for BA.1 (slope 0.3, 95%CI:0.1-0.4). After the 3rd dose, neutralization of BA.1 improved (slope: 0.9 95%CI:0.6-1.2), without differences between DMTs. A fraction of pwMS generated anti-Spike CD4+ and CD8+ T cell response. In contrast, pwMS under antiCD20 generated CD8+TNF+IL2+ response without differences with HC, even in the absence of humoral response. The 3rd dose significantly increased the neutralization against the Omicron, as observed in the immunocompetent population.DiscussionFindings regarding humoral and cellular response are consistent with previous reports.

Background: Immunosuppressive therapies as azathioprine (AZA), mycophenolate mofetil (MMF) and rituximab (RTX) are widely prescribed as first-line treatment to prevent relapses in NMOSD. However, the rate of response to these traditional therapies is unknown in Argentina. We aimed to describe and compare treatment failure rates in NMOSD patients included in the Argentinean MS and NMOSD registry (RelevarEM, NCT 03375177). Methods: A retrospective cohort study was conducted in NMOSD patients included in RelevarEM (a nationwide, longitudinal, observational, non-mandatory registry of MS and NMOSD in Argentina). NMOSD patients were defined based on validate diagnostic criteria. Only NMOSD patients who received AZA or MMF for at least 6 months or RTX for at least 1 month were included. Patients who were receiving AZA, MMF, or RTX and then switched to another 1 of these 3 therapies were included if the above-mentioned criteria for each drug were fulfilled. Data on patient demographics, clinical, neuroradiological findings, and treatments administered were collected. Treatment failure was defined as any new attack/relapse that occurred despite immunosuppressive treatment. Results: We included 139 NMOSD patients who were receiving AZA (n = 105), MMF (n = 5) or RTX (n = 29) with a mean follow-up time of 41.3 +/- 11.4 months and median of EDSS at treatment initiation of 3. We observed a reduction in the annualized relapse rate from pre-treatment to post-treatment of 51.1 %, 48.4 %, and 79.1 % respectively with a Hazard Risk relative to RTX (95 % CI) of 1.67 (1.34-3.54, p = 0.01) for AZA and 2.01 (1.86-4.43, p = 0.008) for MMF. AZA, MMF and RTX failure was observed in 45/105 (42.8 %), 2/5 (40 %) and 3/29 (10.3 %) patients, respectively. Conclusions: Treatment failure rates were higher for AZA and MMF than RTX in Argentinean NMOSD patients in a real-world setting. High-efficacy treatment increases the opportunity to prevent attacks of NMOSD.

We assessed the effectiveness, safety and patient-reported outcomes (PROs) of dimethyl fumarate (DMF) in real-world clinical practice in patients with multiple sclerosis (PwMS) from Argentina. We conducted a multicenter ambispective cohort study in Argentina between September 2020 and March 2023. Changes in annualized relapse rate (ARR), Expanded Disability Status Scale (EDSS) score, magnetic resonance imaging (MRI), no evidence of disease activity (NEDA), PROs (depression, anxiety, fatigue, burden of treatment and quality of life), and safety data were collected at clinical visits performed every 6 months for at least 24 months. We included 161 PwMS (64

Background: Knowledge of the safety and efficacy of disease-modifying therapies (DMTs) in older patients with Multiple Sclerosis (pwMS) is limited due to their exclusion from clinical trials. Our purpose is to evaluate the choice of DMTs in pwMS older than 50 years old in a real-world setting. Methods: Cross-sectional study of pwMS from the Argentine MS and NMOSD Registry. We included patients under 35 and above 50 years old prescribed DMTs. Disease activity was categorized as highly active (HA) or not highly active (NHA), and DMTs were classified as low efficacy therapies (LET) or high efficacy therapies (HET). Results: 1460 patients (65% females) were enrolled. The HA group comprised 241 patients, 198 young (82.2%) and 43 older (17.8%). The NHA group included 1219 patients, 893 young (73%) and 326 older (27%). In the NHA group, older patients received LET more frequently than younger patients (66% versus 44%; p < 0.01). In the HA group, older patients received LET in 61% of cases, whereas younger patients received HET in 71% (p = 0.01). Conclusion: The study shows the preference of LET in older patients regardless of disease activity. However it does not demonstrate a difference in disability in older patients based on low vs high efficacy DMTs used, probably due to the design of the study. Further longitudinal studies are warranted to address this issue.

We aimed to assess the treatment strategies utilized in patients with neuromyelitis optica spectrum disorder (NMOSD) experiencing relapses, including their frequency, types, and response after 6 months based on the Expanded Disability Status Scale (EDSS) score. Methods: We conducted a retrospective study involving NMOSD patients from the Argentinean MS and NMOSD registry (RelevarEM, NCT 03375177). Treatment response at 6 months was categorized as "good" if the EDSS score decreased by >1 point after a nadir EDSS score <= 3, or by >= 2 points after a nadir EDSS score > 3, "poor" if the EDSS score decrease was slighter, and as "absent" if the EDSS score remained unchanged or worsened. Results: We included 120 NMOSD patients (seropositive N = 75), who experienced 250 NMOSD-related relapses and received 248 treatments. At 6 months, complete recovery was achieved in 70/98 (71.4%) and 15/19 (79%) patients, respectively. Predictors of a "good" response in our regression model were a younger age at disease onset (OR:3.54, CI95% 2.45-5.01, p < 0.0001) and a short delay from onset of relapse to treatment initiation (OR:1.56, CI95% 1.22-2.13, p = 0.004). Conclusions: Approximately two-thirds of patients experienced complete recovery, and younger age and a short delay to start treatment were independent predictors of a "good" response.

OBJECTIVE:The first international consensus criteria for optic neuritis (ICON) were published in 2022. We applied these criteria to a prospective, global observational study of acute optic neuritis (ON). METHODS:We included 160 patients with a first-ever acute ON suggestive of a demyelinating CNS disease from the Acute Optic Neuritis Network (ACON). We applied the 2022 ICON to all participants and subsequently adjusted the ICON by replacing a missing relative afferent pupillary defect (RAPD) or dyschromatopsia if magnetic resonance imaging pathology of the optical nerve plus optical coherence tomography abnormalities or certain biomarkers are present. RESULTS:According to the 2022 ICON, 80 (50%) patients were classified as definite ON, 12 (7%) patients were classified as possible ON, and 68 (43%) as not ON (NON). The main reasons for classification as NON were absent RAPD (52 patients, 76%) or dyschromatopsia (49 patients, 72%). Distribution of underlying ON etiologies was as follows: 78 (49%) patients had a single isolated ON, 41 (26%) patients were diagnosed with multiple sclerosis, 25 (16%) patients with myelin oligodendrocyte glycoprotein antibody-associated disease, and 15 (9%) with neuromyelitis optica spectrum disorder. The application of the adjusted ON criteria yielded a higher proportion of patients classified as ON (126 patients, 79%). INTERPRETATION:According to the 2022 ICON, almost half of the included patients in ACON did not fulfill the requirements for classification of definite or possible ON, particularly due to missing RAPD and dyschromatopsia. Thorough RAPD examination and formal color vision testing are critical to the application of the 2022 ICON.