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

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.