Simple algorithm helps improve treatment, reduce disparities in multiple sclerosis

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A simple treatment algorithm may help reduce treatment disparities for Hispanic and Black people with multiple sclerosis, according to a preliminary study released today, March 3, 2025, that will be presented at the American Academy of Neurology’s 77th Annual Meeting taking place April 5–9, 2025, in San Diego and online.

“Studies show Hispanic and Black people have higher levels of disability than white people but are not given prescriptions for the newer, more effective treatments as often as white people are,” said study author Annette Langer-Gould MD PhD, of Kaiser Permanente Southern California in Los Angeles and a member of the American Academy of Neurology. “We’re excited that we’ve found a straightforward way to rapidly increase the use of these medications among all three groups, greatly improving their health.”

The program uses an algorithm to determine the best disease-modifying treatments for people with multiple sclerosis. The algorithm uses readily available clinical factors such as weakness and bladder dysfunction, and also considers social factors such as out-of-pocket costs, transportation barriers, childcare and work schedules, but not race and ethnicity.

The intervention can match people to newer treatments that are highly effective at reducing multiple sclerosis relapses, including medications like natalizumab, rituximab and ofatumumab. Relapses are when multiple sclerosis symptoms like numbness, weakness, stiffness or vision problems appear for at least 24 hours. Because some of these drugs are expensive, not everyone with multiple sclerosis may be able to use them, which can widen health disparities.

The study involved 1,741 Hispanic people, 978 Black people and 3,400 white people with multiple sclerosis who were being treated with disease-modifying therapies.

Three years before the start of the study, Hispanic people had a higher annual relapse rate than white people, with 245 relapses compared to 156 relapses per 1,000 person-years. Person-years represent both the number of people in the study and the amount of time each person spends in the study. Black people had a higher relapse rate than white people during one year of the study.

Over the 12-year study, researchers found all three groups had an increased use of highly effective therapies, primarily rituximab, which is less expensive and can be given once a year or less. For Hispanic people, there was an 89% increase in use of highly effective therapies, for Black people an 87% increase, and for white people, 83%.

After adjusting for age and sex, researchers reported a decline in the annual relapse rate for each group. The decline was greatest among Hispanic people at 90% fewer relapses per year, white people at 86%, and Black people at 82%. By the end of the study, there was no longer a significant difference in the annual relapse rate among Hispanic, Black and white people.

“It is encouraging that our program led to more effective treatments for people with multiple sclerosis resulting in a large reduction in relapse rates among Hispanic, Black and white people,” said Langer-Gould. “We show that using an algorithmic approach to increase the use of highly effective medications, particularly an affordable one like rituximab, can reduce racial and ethnic disparities in multiple sclerosis and greatly improve outcomes for all people with relapsing forms of multiple sclerosis.”

A limitation of the study was that it did not assess long-term disability or whether starting highly effective treatments at diagnosis is more beneficial than delaying these treatments until later in the disease course.

Source: News Release
American Academy of Neurology
March 5, 2025