African American Patients Have Higher MS Disability Scores Than Hispanic, Caucasian Patients

Carlos Perez, MD

African Americans with multiple sclerosis (MS) had higher disability scores followed by Hispanic and Caucasian patients, according to the results of a recent study.¹

These findings were presented at the Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS) Forum 2021, February 25-27, by Carlos Perez, MD, Multiple Sclerosis and Neuroimmunology Fellow, University of Texas Health Science Center McGovern Medical School. He and colleagues noted that the chronic central nervous system disease is known to have a varying prevalence and incidence in different races and ethnicities.

“As compared with Caucasian individuals of European descent, African Americans and Hispanics have a lower risk of developing MS, but a greater risk of disability. Nevertheless, minority population enrollment in phase 3 MS studies has remained below 10% since the 1990s, which calls into question the efficacy profiles of MS treatments and limits generalizability of evidence-based approaches to therapy,” Perez and colleagues wrote.

Perez and colleagues conducted an exploratory analysis of clinical, socioeconomic, and disability data in order to compare patterns of disease modifying therapies (DMT) use by race and ethnicity, as well as to characterize sociodemographic and clinical characteristics between Hispanic, African American, and Caucasian patients with MS. 

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Altogether, the researchers analyzed data from 150 patients with MS: 50 Hispanic, 50 African American, and 50 Caucasian age- and gender-matched patients. The patients had a mean age of 44.9 years (standard deviation [SD], 11.5) and 72% were women (n = 108). They used 2-sample t-tests or Wilcoxon rank sum tests for continuous variable analysis, and Chi-square or Fisher exact tests for categorical variables.

Perez and colleagues found that there were no significant differences in diagnostic lag or disease duration between races or ethnicities. Smoking status, body mass index (BMI), and comorbidities were similar between the 3 groups, however, African Americans had significantly lower baseline vitamin D levels than the other groups.

The researchers found that African Americans were more likely to become disabled and lose employment (62%; n = 31) compared to the other groups (P = .02). Across racial groups, glatiramer acetate was the most commonly prescribed initial DMT, and Hispanic patients were found to be more likely to remain on this therapy (61%; n = 31) compared to African Americans (48%; n = 24) and Caucasians (33%; n = 17).

Of the 38% (n = 57) of patients who required escalation of therapy, 62.9% (n = 36) of them were African American. Overall, African American patients were less likely to respond to injectable therapies and had the highest overall rate of adverse events (36%, n = 18), especially with interferons (61.1%; n = 31).

“While vitamin D levels were lower in African Americans, this was not a potential contributor to disability observed amongst Hispanics. Differential responses to therapy and tolerability profiles may exist based on race and ethnicity,” Perez and colleagues concluded.

Other findings include Caucasian patients being less likely to tolerate glatiramer acetate (70%; n = 35) and Hispanic patients being more likely to discontinue treatment (10%; n = 5). The researchers also found that patients on ocrelizumab (Ocrevus; Genentech) were less likely to switch to a different DMT over time across all groups. 

Additional data presented at ACTRIMS Forum 2021 by Alana Jones, MD-PhD graduate student, University of Alabama at Birmingham, explored some demographic differences in treatment at the University of Alabama at Birmingham MS Center that were treated with ocrelizumab through January 2020. The data suggested that African American patients with MS who switched to ocrelizumab were younger at the time of switch compared to other patients, “likely secondary to more aggressive disease or potentially differential response to DMT,” they wrote.²

For more coverage of ACTRIMS Forum 2021, click here.

REFERENCES

1. Perez CA, Elsehety MA, Agyei PB, Orlando CM, Singh SK, Lincoln JA. Patterns of disease-modifying treatment use and sociodemographic characteristics in multiple sclerosis by race and ethnicity. Presented at ACTRIMS Annual Forum; February 25-27, 2021. Poster CE1.4
2. Manouvakhova O, Jones A, Bashir K. Observations regarding ocrelizumab use at a tertiary referral MS center. Presented at ACTRIMS Annual Forum; February 25-27, 2021. Poster P076