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Background: Timely initiation of disease modifying therapy is crucial for managing multiple sclerosis (MS). Objective: We aimed to validate a previously published predictive model of individual treatment response using a non-overlapping cohort from the Middle East. Methods: We interrogated the MSBase registry for patients who were not included in the initial model development. These patients had relapsing MS or clinically isolated syndrome, a recorded date of disease onset, disability and dates of disease modifying therapy, with sufficient follow-up pre- and post-baseline. Baseline was the visit at which a new disease modifying therapy was initiated, and which served as the start of the predicted period. The original models were used to translate clinical information into three principal components and to predict probability of relapses, disability worsening or improvement, conversion to secondary progressive MS and treatment discontinuation as well as changes in the area under disability-time curve (ΔAUC). Prediction accuracy was assessed using the criteria published previously. Results: The models performed well for predicting the risk of disability worsening and improvement (accuracy: 81%–96%) and performed moderately well for predicting the risk of relapses (accuracy: 73%–91%). The predictions for ΔAUC and risk of treatment discontinuation were suboptimal (accuracy < 44%). Accuracy for predicting the risk of conversion to secondary progressive MS ranged from 50% to 98%. Conclusion: The previously published models are generalisable to patients with a broad range of baseline characteristics in different geographic regions. [ABSTRACT FROM AUTHOR]

Background: The multiple sclerosis (MS) landscape has changed over the past two decades across the world and in the Middle East. The Middle East is an ethnically diverse region located between 12° and 42° of latitude and 35° and 54° of longitude and varying altitudes. The magnitude of the shifts observed in the epidemiology and management of MS differ in each region and from country to country. Objectives: The aim of this study was to provide a clinicodemographic overview of the cohorts of patients contributed to MSBase, a large international MS registry, in the Middle East and describe disease-modifying treatment (DMT) utilization in the different countries within the region. Understanding the differences between these cohorts is integral to interpretation of the studies conducted using registry data and provides insight into clinical practice in these cohorts. Methods: The MSBase registry was searched for patients with MS or clinically isolated syndrome from the Middle Eastern countries with data captured between 2009 and 2018. In 2-year epochs, and with special focus on the most recent epoch (2017–2018), we explored the demographic, clinical characteristics and treatment exposures of the studied cohorts and reported the results using standard descriptive statistics. Results: Over the 10-year study period, 13,356 patients from 17 centers in 8 Middle Eastern countries fulfilled the inclusion criteria. The represented countries were Egypt, Iran, Kuwait, Lebanon, Oman, Saudi Arabia, Turkey and the United Arab Emirates. Overall, the represented cohort was young (median 36 years, quartiles 29–45) and captured relatively early after the onset of MS (median disease duration < 10 years, quartiles 3–12). The relapsing-remitting phenotype was the most prevalent phenotype in all countries (73–97%) and the highest proportion of progressive MS was reported in Saudi Arabia (12%). Median Expanded Disability Status Scale (EDSS) ranged from 0 to 3, depicting a mildly disabled cohort, with the exception of Saudi Arabia where the median EDSS was 4 (quartiles 1.5–6.5). The median relapse frequency was highest in Lebanon (median 1.03, 95% CI 0.94–1.16) followed by Egypt (median 1.02, 95% CI 0.89–1.24) and lowest in Saudi Arabia (median 0.70, 95% CI 0.58–0.95) and Kuwait (median 0.75, 95% CI 0.71–0.80). The treatment landscape greatly varied between different countries. Platform injectable therapies were mostly utilized in Egypt, Iran and Turkey (86%, 79% and 53%, respectively), while oral therapies and monoclonal antibodies were more commonly used in Kuwait, Lebanon and the United Arab Emirates (87.2%, 67.3% and 58.7%, respectively). Conclusion: Patients in the Middle East enrolled in a large multinational registry are representative of the general MS population. The spectrum of therapies used in the individual countries, however, is highly variable. Further studies that include rural and non-academic practices are needed to enhance our understanding of the MS cohorts in the Middle East. [ABSTRACT FROM AUTHOR]

How to improve environmental quality and achieve human development remains major sustainability issues, particularly in the MENA region (the Middle East and North Africa). Most of the empirical literature fails to consider human well-being and environmental quality together although these concepts are fundamentally similar in their concern for distributive justice. This inquiry uses panel data for 13 MENA countries over the period 1990–2016 to examine the association between human development and ecological footprint and test whether trade-off nexus holds between these two sustainability-based indicators. To increase the policy relevance of this inquiry, the MENA region is divided into two sub-groups of countries: seven oil exporting countries and six non-oil exporting countries. The highlights pointed out the presence of a strong trade-off between the ecological footprint and human well-being captured by human development index for the whole sample and across the two subsamples. The crucial role played by economic institutions may help the MENA countries to mitigate the trade-offs to achieve simultaneously both targets of human well-being and environmental protection. Our empirical insights have important implications for achieving human development sustainability through the pursuit of the individual SDG targets. • This study aims to examine the trade-off between human well-being and environmental concerns. • 13 MENA countries divided into 7 oil exporting and 6 non-oil exporting countries were investigated. • Interactive Fixed Effects (IFE) and Common Correlated Effects Mean Group (CCEMG) are used for estimation. • Our main findings confirm the trade-off nexus between human well-being and environmental concerns. • Economic institutions reverse the trade-off between human development and ecological footprint. [ABSTRACT FROM AUTHOR]