March 13, 2025 Story by: Editor
A simple algorithm designed to recommend highly effective disease-modifying therapies (DMTs) for multiple sclerosis (MS) patients can help ensure fairer treatment and reduce racial and ethnic disparities, according to a new study by U.S. researchers.
The study, conducted over 12 years in Southern California, found that using this algorithm significantly increased access to high-efficacy medications for Black and Hispanic MS patients—groups that have historically been prescribed such treatments less frequently. The use of these medications among Hispanic and Black individuals rose by more than 85%, while white patients also saw an over 80% increase in access.
By selecting treatments based on clinical and social factors—excluding race or ethnicity—the algorithm helped achieve similar relapse rates across all racial and ethnic groups.
“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,” said Annette Langer-Gould, MD, PhD, an MS specialist at Los Angeles Medical Center and the study’s first author, in a press release issued by the American Academy of Neurology (AAN).
These findings will be presented at the 2025 AAN annual meeting, scheduled for April 5-9 in San Diego and online. The presentation is titled “Equitable Implementation of Highly Efficacious Treatments for Multiple Sclerosis.”
Addressing the Treatment Gap in MS
MS is a neurodegenerative disease in which the immune system attacks the protective myelin sheath around nerve cells, leading to disability over time. While effective treatments exist to reduce inflammation and prevent relapses, research shows that Black and Hispanic individuals with MS often develop symptoms earlier and experience more severe disability than white patients. However, they are less frequently prescribed newer, high-efficacy treatments.
“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 Kaiser Permanente team focused on high-quality, affordable MS care.
To address these disparities, her team developed an algorithm-based program that recommends treatment based on clinical factors like weakness and bladder dysfunction, as well as social factors such as out-of-pocket costs, transportation, childcare, and work schedules—while excluding race or ethnicity.
Study Results Show Increased Treatment Use Across All Groups
The study analyzed data from 978 Black, 1,741 Hispanic, and 3,400 white MS patients receiving DMTs at Kaiser Permanente Southern California. Researchers compared the use of high-efficacy medications and relapse rates before the algorithm was introduced (2009-2011) and after its implementation (2012-2023).
Before the program, Hispanic patients had a higher annual relapse rate than white patients (245.1 vs. 156.3 relapses per 1,000 person-years). Black patients also had a higher relapse rate than white patients, though the difference was only statistically significant in 2015.
Following the implementation of the algorithm, treatment with highly effective medications increased by:
- 89.3% among Hispanic patients
- 87.4% among Black patients
- 82.9% among white patients
Most patients were prescribed rituximab, a cost-effective antibody-based therapy commonly used off-label for MS.
Relapse Rates Drop, Eliminating Racial Disparities
The study found that greater access to highly effective treatment led to a significant reduction in relapse rates across all groups. By 2023, relapse rates had decreased by:
- 90% among Hispanic patients
- 86% among white patients
- 82% among Black patients
As a result, there was no longer a significant difference in relapse rates between racial and ethnic 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.
Study Limitations and Future Research
While the findings highlight the potential of algorithm-based treatment approaches, the study did not assess long-term disability outcomes or whether starting high-efficacy DMTs at the time of diagnosis yields better results than waiting until later. Further research is needed to explore these factors, according to the AAN.
Source: Multiple Sclerosis News Today
