Original article| Volume 56, 103248, November 2021

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

Published:September 08, 2021DOI:


      • Disparities in therapy response and tolerability may exist based on race/ethnicity.
      • In this study, minority groups had poorer outcomes despite similar treatment patterns.
      • Therapy outcome can contribute to multi-ethnic health disparities in MS.



      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.


      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.


      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.


      Racial/ethnic disparities in treatment outcome create an unmet need to identify tailored, multifaceted approaches to therapy selection in MS.

      Graphical abstract


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        • Reingold S.C.
        Prevalence estimates for MS in the United States and evidence of an increasing trend for women [3](multiple letters).
        Neurology. 2002; 59: 294-295
        • Dobson R.
        • Jitlal M.
        • Marshall C.R.
        • et al.
        Ethnic and socioeconomic associations with multiple sclerosis risk.
        Ann. Neurol. 2020; (Epub ahead of print)
        • Robers M.V.
        • Soneji D.
        • Amezcua L.
        Multiple sclerosis treatment in racial and ethnic minorities: systematic literature review shows little evidence to guide treatment.
        Pract. Neurol. 2020; : 49-54
        • Lewis M.J.
        • Jawad A.S.
        The effect of ethnicity and genetic ancestry on the epidemiology, clinical features and outcome of systemic lupus erythematosus.
        Rheumatology (Oxford). 2017; 56: i67-i77
        • Cree B.A.C.
        • Stuart W.H.
        • Tornatore C.S.
        • et al.
        Efficacy of natalizumab therapy in patients of African descent with relapsing multiple sclerosis analysis of AFFIRM and SENTINEL data.
        Arch. Neurol. 2011; 68: 464-468
        • Cree B.A.C.
        • Al-Sabbagh A.
        • Bennett R.
        • et al.
        Response to interferon beta-1a treatment in African American multiple sclerosis patients.
        Arch. Neurol. 2005; 62: 1681-1683
        • Williams M.J.
        • Amezcua L.
        • Okai A.
        • et al.
        Real-world safety and effectiveness of dimethyl fumarate in African American patients with multiple sclerosis: 3-Year Results from ESTEEM.
        Neurol. Ther. 2020; 9: 483-493
        • Buchanan R.J.
        • Zuniga M.A.
        • Carrillo-Zuniga G.
        • et al.
        Comparisons of Latinos, African Americans, and Caucasians with multiple sclerosis.
        Ethn. Dis. 2010; 20: 451-457
        • Zhovtis Ryerson L.
        • Green R.
        • Confident G.
        • et al.
        Efficacy and tolerability of dimethyl fumarate in White-, African- and Hispanic- Americans with multiple sclerosis.
        Ther. Adv. Neurol. Disord. 2016; 9: 454-461
        • Zhang F.
        • Finkelstein J.
        Inconsistency in race and ethnic classification in pharmacogenetics studies and its potential clinical implications.
        Pharmgenomics Pers. Med. 2019; 12: 107-123
        • Coelho V.
        • Pereira S.R.
        • Malfetano F.R.
        • et al.
        Clinical response to interferon beta and glatiramer acetate in multiple sclerosis patients: a Brazilian cohort.
        Arq. Neuropsiquiatr. 2012; 70: 774-779
        • Pérez C.A.
        • Salehbeiki A.
        • Zhu L.
        • et al.
        Assessment of racial/ethnic disparities in volumetric MRI correlates ofclinical disability in multiple sclerosis: a preliminary study.
        J. Neuroimaging. 2021; 31: 115-123
        • Culpepper W.J.
        • Marrie R.A.
        • Langer-Gould A.
        • et al.
        Validation of an algorithm for identifying MS cases in administrative health claims datasets.
        Neurology. 2019; 92: E1016-E1028
        • Kappos L.
        • Fox R.J.
        • Burcklen M.
        • et al.
        Ponesimod Compared with Teriflunomide in Patients with Relapsing Multiple Sclerosis in the Active-Comparator Phase 3 OPTIMUM Study: a Randomized Clinical Trial.
        JAMA Neurol. 2021; (Epub ahead of print)
        • Brown J.W.L.
        • Coles A.
        • Horakova D.
        • et al.
        Association of initial disease-modifying therapy with later conversion to secondary progressive multiple sclerosis.
        JAMA. 2019; 321: 175-187
        • Kern D.M.
        • Cepeda M.S.
        Treatment patterns and comorbid burden of patients newly diagnosed with multiple sclerosis in the United States.
        BMC Neurol. 2020; 20 (Epub ahead of print 11 August)
        • Merkel B.
        • Butzkueven H.
        • Traboulsee A.L.
        • et al.
        Timing of high-efficacy therapy in relapsing-remitting multiple sclerosis: a systematic review.
        Autoimmun. Rev. 2017; 16: 658-665
        • Ge Y.
        • Grossman R.I.
        • Udupa J.K.
        • et al.
        Brain atrophy in relapsing-remitting multiple sclerosis: fractional volumetric analysis of gray matter and white matter 1.
        Neuroradiology. 2001; 220: 606-610
        • Williams M.J.
        • Johnson K.
        • Trenz H.M.
        • et al.
        Adherence, persistence, and discontinuation among Hispanic and African American patients with multiple sclerosis treated with fingolimod or glatiramer acetate.
        Curr. Med. Res. Opin. 2018; 34: 107-115
        • Chinea A.
        • Lilyana Amezcua L.
        • Vargas W.
        • et al.
        Real-world safety and effectiveness of dimethyl fumarate in Hispanic or Latino patients with multiple sclerosis: 3-Year results from ESTEEM.
        Neurol. Ther. 2020; 9: 495-504
        • Morillo Verdugo R.
        • Herráiz E.R.
        • Del Olmo O.R.F.
        • et al.
        Adherence to disease-modifying treatments in patients with multiple sclerosis in Spain.
        Patient Prefer Adherence. 2019; 13: 261-272
        • Amezcua L.
        • Lund B.T.
        • Weiner L.P.
        • et al.
        Multiple sclerosis in Hispanics: a study of clinical disease expression.
        Mult. Scler. J. 2011; 17: 1010-1016
        • Chitnis T.
        • Prat A.
        A roadmap to precision medicine for multiple sclerosis.
        Mult. Scler. J. 2020; 26: 522-532
        • Kalincik T.
        • Manouchehrinia A.
        • Sobisek L.
        • et al.
        Towards personalized therapy for multiple sclerosis: prediction of individual treatment response.
        Brain. 2017; 140: 2426-2443
      1. Pérez C.A., Elsehety M.A., Agyei P.B., et al. Patterns of disease-modifying treatment use and sociodemographic characteristics in multiple sclerosis by race and ethnicity,!/9245/presentation/59 (2021, accessed 15 April 2021).

        • Khan D.A.
        • Phillips E.J.
        Pharmacogenomic biomarkers in allergy and immunology practice.
        J. Allergy Clin. Immunol. 2020; 146: 509-512
        • Bose G.
        • Freedman M.S.
        Precision medicine in the multiple sclerosis clinic: selecting the right patient for the right treatment.
        Mult. Scler. J. 2020; 26: 540-547
        • Kulakova O.
        • Bashinskaya V.
        • Kiselev I.
        • et al.
        Pharmacogenetics of glatiramer acetate therapy for multiple sclerosis: the impact of genome-wide association studies identified disease risk loci.
        Pharmacogenomics. 2017; 18: 1563-1574
        • Coyle P.K.
        Pharmacogenetic biomarkers to predict treatment response in multiple sclerosis: current and future perspectives.
        Mult. Scler. Int. 2017; 2017: 1-10
        • Thiele Née Schrewe L.
        • Guse K.
        • Tietz S.
        • et al.
        Functional relevance of the multi-drug transporter abcg2 on teriflunomide therapy in an animal model of multiple sclerosis.
        J. Neuroinflammation. 2020; 17 (Epub ahead of print 8 January)
        • Touma J.A.
        • McLachlan A.J.
        • Gross A.S.
        The role of ethnicity in personalized dosing of small molecule tyrosine kinase inhibitors used in oncology.
        Transl. Cancer Res. 2017; 6: S1558-S1591
        • Osathanugrah P.
        • Sanjiv N.
        • Siegel N.H.
        • et al.
        The impact of race on short-term treatment response to bevacizumab in diabetic macular edema.
        Am. J. Ophthalmol. 2021; 222: 310-317
        • Lee B.
        • Holt E.W.
        • Wong R.J.
        • et al.
        Race/ethnicity is an independent risk factor for autoimmune hepatitis among the San Francisco underserved.
        Autoimmunity. 2018; 51: 258-264