Algorithm may reduce racial, ethnic inequalities in MS treatment: Study
Its use led to more recommendations for DMTs for Black, Hispanic patients
Using a simple algorithm to recommend highly effective disease-modifying therapies (DMTs) for people with multiple sclerosis (MS) can help make treatment fairer for all patients, and level inequalities otherwise defined by race or ethnicity, a new study by U.S. researchers suggests.
Indeed, use of the algorithm over a dozen years among MS patients in Southern California was linked to an increase of more than 85% in treatment with highly effective medications among Hispanic and Black individuals, who are less frequently offered such therapies for the neurodegenerative disease, according to the researchers. An increase of more than 80% was also seen for white MS patients.
The use of the algorithm, which determines the best treatment based on certain clinical factors as well as social factors other than race or ethnicity, resulted in similar relapse rates regardless of whether patients were Black, Hispanic, or white, study data showed.
“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,” Annette Langer-Gould, MD, PhD, an MS specialist at Los Angeles Medical Center and the study’s first author, said in a press release issued by the American Academy of Neurology (AAN).
The researchers will present these data at the 2025 AAN annual meeting, which will take place April 5-9 in San Diego and virtually. This presentation will be titled “Equitable Implementation of Highly Efficacious Treatments for Multiple Sclerosis.”
In their abstract for the presentation, the researchers concluded that “implementing an algorithmic approach to increase HET [highly efficacious treatments] use … can reduce racial and ethnic disparities in MS outcomes.”
Using an algorithm to try to close treatment gap between racial, ethnic groups
In MS, the immune system launches attacks on the myelin sheath that protects nerve cells, causing them to become damaged and resulting in a variety of disease symptoms. However, available treatments can reduce the inflammatory attacks that mark MS, preventing relapses and slowing the accumulation of disability.
Black and Hispanic people with MS have been found to often develop symptoms at younger ages, and to experience more severe disability over time. But these patients tend to receive less effective medications than their white counterparts, suggesting that the best treatment may not be available to everyone.
“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 Langer-Gould, who leads a team at Kaiser Permanente that develops programs for high-quality affordable care in MS.
To close the gap between racial or ethnic groups, Langer-Gould’s team developed a program that uses an algorithm to match treatment to patients based on clinical factors such as weakness and bladder dysfunction. It also considers social factors other than race or ethnicity, such as out-of-pocket costs, transportation issues, childcare concerns, and patient work schedules.
The team’s study used data from 978 Black patients, 1,741 Hispanic patients, and 3,400 white patients receiving DMTs at Kaiser Permanente Southern California. The researchers watched for differences in the use of highly effective medications and relapse rates between 2009 and 2011, before the program was put in place, and then from 2012 to 2023, or after its implementation.
Before the program, Hispanic patients had a higher annual relapse rate than white patients: 245.1 versus 156.3 relapses per 1,000 person-years. Person-years measure both the number of people in a study and the total time each individual spends in the study.
Black patients also had a higher annual relapse rate than white patients before the program and in the first years following its implementation, but this difference was only significant in 2015.
Use of DMTs increased by over 80% for all MS patients in study
During the 12 years the program was used, the researchers noted increases of more than 80% for all patients in the use of highly effective medications. This was mainly rituximab, an antibody-based therapy that works to deplete B-cells. While not approved as an MS treatment, rituximab is commonly used off-label, and is generally much more affordable than other high efficacy DMTs.
The use of highly effective medicines increased by 89.3% among Hispanic patients, by 87.4% in Black patients, and by 82.9% in white patients.
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 MS and greatly improve outcomes for all people with relapsing forms of MS.
With more effective treatment, according to Langer-Gould, came “a large reduction in relapse rates among Hispanic, Black and white people.”
By 2023, relapse rates had dropped by 90% in Hispanic, 86% in white, and 82% in Black patients, per the release. Because of this, there was no longer a significant difference in relapse rates between groups.
“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 MS and greatly improve outcomes for all people with relapsing forms of MS,” Langer-Gould said.
A limitation of the study is that it didn’t look at changes in long-term disability or whether starting highly effective disease-modifying medications at the time of diagnosis is better than waiting until later, according to the AAN.
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