Neuroimmunological Shifts in Disease-Modifying Therapy Use Among Multiple Sclerosis Patients: A Regional Study from Sulaymaniyah, Iraq

Zana Abdulrahman Mohammed; Sadeek Hama Aziz Salih; Savan Mohammed Dilshad Ahmed; Hazhmat Ali; Rafl Malek Kamil; Tariq Mohammad Amin; Kubra Kilic

doi:10.54133/ajms.v11i2.3387

Authors

Zana Abdulrahman Mohammed Department of Neurology, College of Medicine, University of Sulaimani, Sulaimani, Kurdistan Region, Iraq https://orcid.org/0009-0005-9069-3692
Sadeek Hama Aziz Salih Branch of Clinical Sciences, College of Medicine, University of Sulaimani, Sulaimani, Kurdistan Region, Iraq https://orcid.org/0009-0004-9848-4265
Savan Mohammed Dilshad Ahmed Outpatient Department (OPD) Pharmacy Section, Shar Hospital, Sulaymaniyah, Iraq; Komar University of Science and Technology, Sulaymaniyah, Iraq https://orcid.org/0009-0005-9084-6900
Hazhmat Ali College of Medicine, University of Duhok, Duhok, 42001, Kurdistan Region, Iraq https://orcid.org/0000-0002-2553-8443
Rafl Malek Kamil Department of Pharmaceutical Technology, Faculty of Pharmacy, Universiti Malaya, 50603 Kuala Lumpur, Malaysia https://orcid.org/0009-0001-2213-5710
Tariq Mohammad Amin Department of Neurology, Amager and Hvidovre Hospital, Kettegård Alle 36, 2650 Hvidovre, Denmark
Kubra Kilic Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark

DOI:

https://doi.org/10.54133/ajms.v11i2.3387

Keywords:

Disease-modifying therapy, Corticosteroids, Geographical distribution, Multiple sclerosis

Abstract

Background: Multiple sclerosis (MS) is a chronic demyelinating disease of the central nervous system with a growing global prevalence. In Iraq, diagnostic rates are increasing alongside changes in environmental exposures. Objective: To describe the regional epidemiological burden of MS and the patterns of disease-modifying therapy (DMT) prescriptions in Sulaymaniyah, stratified by gender, age, and temporal changes in therapeutic approaches to immune-targeted treatments. Methods: This retrospective, registry-based observational study utilized data from the Shar Hospital MS registry (2007-2025). A total of 697 confirmed MS cases were identified, of which 643 were eligible for therapeutic analysis. Extracted variables included age, sex, residential area, and prescribed DMTs. Temporal changes in DMT prescribing and associations between sex and DMT type were analyzed using chi-square tests, while age differences by sex were assessed using independent-samples t-tests. Results: The cohort was mainly female (72.6%), with a mean age of 42.86±13 years. No significant difference in mean age was seen between sexes (p=0.60). DMT prescribing patterns changed notably over time (p<0.001), with less use of broad immunomodulators such as fingolimod and interferon beta and more use of high-efficacy immune-targeted therapies, especially B-cell-depleting monoclonal antibodies. No statistically significant link was found between sex and DMT type (p=0.066). Conclusions: In this registry-based cohort, MS mainly affected females, and DMT prescribing shifted over time toward higher-efficacy immune-targeted therapies. Prospective studies incorporating clinical outcomes such as relapse activity, disability progression, and MRI measures are needed to assess the effectiveness and long-term impact of these evolving treatment strategies in this setting.

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