Heterogenous symptoms, varied treatment response: MS as an individualized disease
Jacqueline F. Rosenthal, MD, a neurologist with the Andrew C. Carlos Multiple Sclerosis Institute, spoke with Healio about symptom differences in multiple sclerosis, responses to therapies and treatments and the impact of racism in MS.
Does MS present differently in different persons? How stark are the symptom differences?
MS is extremely heterogeneous and presents differently amongst everyone, which is why it is important to not compare one person’s MS directly to another’s. That being said, when looking at racial/ethnic groups, it appears that Black Americans with MS may have more aggressive symptoms, more frequent relapses and increased disability compared hite Americans.
As an example, more Black and Hispanic/Latino Americans tend to present with involvement of the optic nerve(s) and/or spinal cord can be associated with more pronounced symptoms. There is also suggestion that there may be more pronounced brain volume loss amongst Black Americans compared to the MS population.
How does racism impact patient outcomes in MS?
Racism and health inequality can impact one’s access to care. This is important because with poor access to care, MS patients are less likely to be diagnosed or receive appropriate treatments can have long-term implications as it relates to disability. In addition, our country’s history of racism has led to patients concerns for safety and feelings of mistrust toward the medical community further complicates this issue.
Can you give a summary of multiple sclerosis modifying therapies and treatments that are focused on ethnic minority groups?
There are no disease modifying therapies that are specifically designed for just one particular ethnic group; however, to confidently available therapies in all groups of people, it is important to study the effects of these medications in all groups of people in clinical research. There is literature to suggest that there may be differences in response to modifying treatments based on racial/ethnic groups. Currently, ethnic minorities, Black Americans in particular, are under-represented in clinical trials and so there are efforts in place to try to ensure adequate representation. As an example, there is presently a study entitled CHIMES (CHaracterization of ocrelizumab In Minorities with multiplE Sclerosis trial) that is looking specifically that the Black and Hispanic/Latino populations.
What support systems need to be created or improved to assist and support Black patients managing MS?
Systems and programs should have a focus on education and awareness as it relates to MS, available treatments (both disease-modifying and symptomatic treatments) and research opportunities.
What is needed from clinicians for improved screening and management of Black patients with MS?
Clinicians should recognize the potential differences in MS presentation and implications for treatments between ethnic minorities. For example, individuals with a more aggressive onset of disease may require higher efficacy treatments early on. In addition to this, clinicians should be aware of the barriers that may impact their patients, to include cultural and socioeconomic barriers. There should also be a focus on building trust to strengthen the relationship between clinicians and patients.