#AAN2018 – MS Progresses Quickly in African-Americans and May Warrant Aggressive Treatment

Multiple sclerosis in African-Americans progresses much faster than in Caucasian patients, new research reports, suggesting that blacks would benefit from a more aggressive treatment approach.

Led by researchers at Johns Hopkins University and presented at the American Academy of Neurology (AAN) annual meeting taking place in Los Angeles through April 27,  the study is titled “Longitudinal assessment of rates of brain and retinal atrophy in African American versus Caucasian American patients with Multiple Sclerosis.”

Mounting evidence points to multiple sclerosis (MS) progressing more quickly in blacks — marked by greater inflammatory disease activity and faster disability accumulation — than whites in the U.S., the team reported.

To further confirm such findings, the researchers evaluated and compared brain lesion progression and retinal atrophy rates in these two MS patient groups.

Brain lesions and alterations were evaluated by brain magnetic resonance imaging (MRI) scans. Retinal atrophy, linked to vision problems like optic neuritis in MS, was determined by optical coherence tomography (OCT), which measures in detail changes in retinal structures like nerve fiber layers.

Brain lesion progression was evaluated over a mean of 4.61 years in 28 African- and 28 Caucasian-American patients, while changes to the retina were tracked for a mean of 4.43 years in 116 black and an equal number of white patients.

Progression was found to be significantly faster in both brain and retinal measures in black MS patients.

Specifically, MRI scans showed whole brain, and gray and white matter atrophy at a pace twice as fast in the African-Americans than in Caucasian-Americans.

Blacks also showed faster atrophy of the thalamus, a brain region linked to cognitive impairment in MS.

Retinal layer atrophy rates were also found to be markedly faster in black patients, with  significantly reduced thickness in the retina’s nerve fiber and inner layer, common causes of visual impairment in MS.

Collectively, these results show that African-American MS patients “exhibit more rapid neurodegeneration with accelerated brain and retinal neuro-axonal loss” than Caucasian-American MS patients, the researchers wrote.

“These results corroborate the more rapid clinical progression observed in [black] patients,” raising the possibility that these patients “may benefit from a more aggressive therapeutic approach,” they concluded.