Methodological Quality of Clinical Practice Guidelines for Multiple Sclerosis: A Systematic Review and Comparative Analysis Using AGREE II

Introduction: Multiple Sclerosis (MS) is a neurodegenerative disease causing disability and high healthcare costs, with a global prevalence exceeding 2.8 million people. Consequently, there is a clear need for evidence-based Clinical Practice Guidelines (CPGs) for its diagnosis, treatment, and follow-up. Objective: This study aimed to evaluate and compare the methodological quality of international CPGs for MS management using the AGREE II instrument. Methodology: A systematic search was conducted to identify relevant CPGs. Methodological quality was assessed using the AGREE II instrument across six domains. The weighted mean score of each domain was calculated as a percentage. Seven CPGs published between 2010 and 2023 were included in the evaluation. Results: CPGs from Spain, Mexico, and Chile achieved the highest overall scores (above 70%), primarily due to their clarity and scope. However, critical weaknesses were identified consistently across most guidelines, particularly in Domain 5 (Applicability) and Domain 6 (Editorial Independence), which received the lowest scores. CPGs from Peru (41%) and the UK (45%) scored lowest overall, suggesting issues in methodological reporting. Conclusions: The methodological quality of international MS CPGs is variable, revealing a systemic limitation regarding the participation of stakeholders and the applicability of the recommendations. Enhancing transparency, promoting regular updates, and ensuring broader stakeholder involvement are essential to improve quality standards and facilitate clinical implementation.