Racial and ethnic disparities in treatment response and tolerability in multiple sclerosis: A comparative study

Background: Inter-individual response and tolerability profiles associated with available disease-modifying treatments (DMTs) are an important aspect of the therapeutic decision-making process in multiple sclerosis (MS). In the absence of racially diverse clinical studies, the possible effect of race and ethnicity on treatment outcome remains uncertain. This study aims to compare disease outcome among Hispanic, Black, and White patients with MS, and assess the impact of race/ethnicity on long-term outcome. Methods: A retrospective review of electronic medical records was performed on a multiethnic cohort of MS patients treated in a large academic center. Sociodemographic characteristics, treatment regimens, and disability outcomes were compared between the three groups. Results: A total of 300 age- and gender-matched MS patients (100 Hispanic, 100 Black, and 100 White) were included in the study. When assessing the overall survival of MS patients without ambulatory disability 5 years from diagnosis, Hispanics and Blacks attained lower survival times compared to Whites (survival time ratio [STR] 0.17, p = 0.004; and 0.14, p = 0.002, respectively). Black patients had the highest rate of disease progression and treatment-limiting adverse events despite similar sociodemographic profiles and DMT exposure relative to Hispanics and Whites. Conclusion: Racial/ethnic disparities in treatment outcome create an unmet need to identify tailored, multifaceted approaches to therapy selection in MS.