Medically reviewed by Dr. Kimberly Langdon Cull, M.D. on Oct. 4, 2023
A comprehensive review examined the need for more research into racial and ethnic disparities in MRI findings among multiple sclerosis patients. The study highlights the importance of diversity in clinical trials and customized treatment plans.
- MRI studies reveal varying lesion burdens among different racial and ethnic groups.
- Differential responses to disease-modifying therapies warrant attention in diverse patient groups.
- There’s a need for personalized treatment plans that consider racial and ethnic differences in MRI findings and responses to disease-modifying therapies.
According to a review published in Frontiers in Neurology, MRI plays a pivotal role in diagnosing and monitoring MS. However, there is a glaring gap in research focusing on racial and ethnic differences in MRI findings. African American patients consistently show worse MRI outcomes, including higher lesion burdens and significant atrophy, compared to White patients.
In Latin Americans, findings are more variable and less consistent, partly due to underdiagnosis in certain countries. In Asian populations, particularly among the Japanese, initial data suggests higher burdens on MRI but lower clinical disability scores.
The Urgent Need for Diversity in Clinical Trials and Treatment Options
The review also points to the need for diverse representation in clinical trials. A systematic review of Phase III trials for disease-modifying therapies (DMTs) between 1995 and 2020 showed that a startling 37.8% of trials did not report on race or ethnicity. Among the ones that did, 31.1% only reported data on White patients. Given the differential responses to DMTs among ethnic groups, especiallyAfrican Americans, more inclusive research is urgently needed to create treatment plans that are effective across diverse populations.
DMT Selection: Safety and Efficacy Across Diverse Groups
Clinical considerations in selecting DMTs need to account for these racial and ethnic disparities. Higher-efficacy treatments may have more severe adverse events, including life-threatening outcomes. Moreover, African Americans were found to switch DMTs more frequently due to injection fatigue and perceived lack of efficacy, but were less likely to switch based on side effects. This patient behavior should be considered when prescribing DMTs, along with racial or ethnic background, to ensure both safety and efficacy.
What the Results Mean for Clinical Practice
For healthcare providers, this review underlines the importance of individualized treatment plans that consider racial and ethnic backgrounds in addition to clinical findings. Physicians should also be cognizant of the scarcity of research focusing on diverse groups with MS when making treatment decisions. For example, they can advocate for more inclusive clinical trials that can better inform treatment protocols.
The review also implies that better global access to MRI technology is key to more comprehensive studies. Although an MRI is an important tool for diagnosis and monitoring, a lack of access to this technology can serve as a barrier to understanding MS in diverse populations.
Source:
Nathoo, N., Zeydan, B., Neyal, N., Chelf, C., Okuda, D. T., & Kantarci, O. H. (2023b). Do magnetic resonance imaging features differ between persons with multiple sclerosis of various races and ethnicities? Frontiers in Neurology, 14. https://doi.org/10.3389/fneur.2023.1215774
