African Americans, Hispanics experience more disability in MS
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African American and Hispanic patients with MS were more prone to disability than white patients despite using similar disease-modifying therapies, researchers said.
Further, African Americans were less likely to respond to therapy or to tolerate it.
With some exceptions, studies suggest African American and Hispanic people are at lower risk for MS than white people. However, they experience more disability and are consistently underrepresented in clinical trials. This raises questions about the efficacy of MS treatments and whether evidence-based approaches to therapy are generalizable, according to Carlos A. Pérez, MD, a second-year MS fellow at the The University of Texas Health Science Center at Houston.
Pérez and colleagues analyzed clinical, socioeconomic and disability data from 50 Hispanic, 50 African American and 50 white patients with MS at UTHealth who were matched by age and sex. The mean age of the patients was 44.9±11.5 years, and 72% were women.
Investigators found no racial or ethnic differences in diagnostic lag or disease duration. Except for lower baseline vitamin D levels in African Americans, Pérez and colleagues found no differences in clinical characteristics between the three groups, such as the prevalence of smoking, BMI and comorbid conditions.
Additionally, “most of the patients actually had similar educational levels, and a great majority of them had attained at least a college degree or beyond,” Pérez said during a virtual presentation.
Despite the similarities between the three groups, African Americans were significantly more likely to become disabled or lose employment. Although most patients (74%) had minimal disability on the EDSS overall, twice as many Hispanic (20%) and African American (18%) patients with MS had “substantial disability” compared with white patients (8%), Pérez said.
To look for a possible explanation, the researchers investigated patterns of DMT use over time but found that they were mostly similar across the three groups. Glatiramer acetate was the most commonly prescribed initial DMT among all patients. Among those who required an escalation of therapy (n = 57), 62.9% were African American.
Findings showed that African Americans also were less likely to respond to injectable therapies and experienced the highest overall rate of adverse events (36%), particularly to interferons (61.1%). Of the 45 patients who switched DMTs due to adverse events, close to half (46.7%) were African Americans.
According to Pérez, the findings reinforce the need to better understand how race and ethnicity affects patients’ responses to therapy.
“For this reason, minority representation should be increased in future MS clinical trials in order to improve the accuracy of clinical data and evidence-based treatment guidelines,” he said.