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A new health system intervention improved treatment and reduced relapse rates in multiple sclerosis (MS) for Black, Hispanic, and White patients. This algorithmic approach to highly efficacious treatments (HETs) reduced racial disparities in MS outcomes.

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Area of Science:

  • Neurology
  • Health Services Research
  • Health Equity

Background:

  • Multiple sclerosis (MS) treatment advances have not benefited all racial and ethnic groups equally.
  • Minority populations experience disparities in MS treatment and outcomes.

Purpose of the Study:

  • To assess the equitable implementation and impact of a health system intervention designed to increase the use of highly efficacious treatments (HETs) for MS.
  • To determine if the intervention led to similar improvements in MS outcomes across different racial and ethnic groups.

Main Methods:

  • An MS treatment algorithm was developed, aligning disease-modifying therapies (DMTs) with patient risk and incorporating social determinants of health and preferences.
  • A trend study analyzed DMT utilization and annual relapse rates (ARRs) from electronic health records (2009-2023), stratified by race and ethnicity.
  • The algorithm did not use race or ethnicity in its decision-making process.

Main Results:

  • Over 12 years, HET use increased significantly across all groups, with the highest increase among Hispanic patients (89.3%), followed by Black (87.4%) and White (82.9%) patients.
  • Age- and sex-adjusted ARRs declined substantially, with the greatest reduction observed in Hispanic patients (90%), followed by White (86%) and Black (82%) patients.
  • By 2023, clinically significant differences in ARR between racial and ethnic groups were eliminated.

Conclusions:

  • The health system intervention successfully promoted equitable use of HETs and reduced relapse rates in MS patients across racial and ethnic groups.
  • An algorithmic approach to increasing HET use, particularly with affordable options like rituximab, can effectively mitigate racial and ethnic disparities in MS outcomes.