Addressing Health Equity for Multiple Sclerosis Management in Diverse Patient Populations

Clyde E. Markowitz, MD, Associate Professor of Neurology Emeritus Director, Multiple Sclerosis Center Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, discussed the racial disparities in treatment for multiple sclerosis (MS) and a need to individualize treatment based on patient considerations, during a virtual bonus presentation at Neurology Week.

“The variation in MS disease course and healthcare access among minority groups is revealing clinical practice gaps that must be addressed in order to ensure health equity and optimal care for these patients,” Dr Markowitz said.

Minorities with MS, particularly the African American and Hispanic populations, are shown to have earlier age at onset and a higher rate of disability.

Several factors contribute to a more aggressive course of disease with worse outcomes for minorities, and Dr Markowitz emphasized a need for upfront, aggressive disease management.

Genetic factors that are associated with MS risk in minority populations include an influence on the age of disease onset; Dr Markowitz shared that African Americans with the (HLA)DRB1*15 allele were two times more likely to have an early age of onset.

Studies have shown that African American and Hispanic patients are at a higher risk of poor prognosis and early disability, with higher disability scores on the Patient-Derived Multiple Sclerosis Severity Score when compared to white patients.

In addition, location before disease onset is a risk factor. Studies of African American and Native American patient populations show a higher risk for early age of disease onset due to geographic location.

Socioeconomic factors including poverty, education, and environment can contribute to disease risk and also impact access to treatment.

“When you look at the clinical trials, less than 10% of clinical trial participation comes from minority patients, and it calls into question about whether or not we can apply our clinical trial data to this population of patients,” Dr Markowitz said.

Patient outreach and education on treatment options, accurate assessment of treatment response, and actively addressing comorbid conditions such as diet and smoking habits are among some practical steps to close the gap in clinical practice and improve the equity of MS treatment, according to Dr Markowitz.

“There is an underpinning fear of exploitation, and this is due to a not-so-distant past, a history in the US about unethical medical practices and testing in the US, so we have to be responsible for that,” Dr Markowitz said. “We have to educate about that and be able to explain why this is really important that we treat them appropriately.”

Markowitz, C. Addressing Health Equity and Optimizing Novel Oral Therapies for Multiple Sclerosis Management in Diverse Patient Populations. Presented at Neurology Week 2021; July 14-18. Virtual.