Dr Mitzi Joi Williams: SDOH, Care Access May Affect MS Outcomes

It is likely that social determinants of health (SDOH) may affect the differences in outcomes from multiple sclerosis (MS) that we see among Black/African American and Hispanic/Latinx populations, absent more data on their genetics and ancestry, noted Mitzi Joi Williams, MD, FAAN.

In this interview about CHIMES trial interim findings that were presented at this year’s American Academy of Neurology annual meeting, Mitzi Joi Williams, MD, FAAN, medical director and CEO, Joi Life Wellness Neurology Clinic, and an investigator on the study, discusses its next steps and the potential influence of social determinants of health/environment on multiple sclerosis (MS) in minority populations.


Does MS manifest differently among races/ethnicities, and if so, can we infer this to mean potential environmental influences on disease course?

There are some studies suggesting that there may be a higher incidence of optic neuritis, as well as spinal cord involvement, in Black and African American and Hispanic and Latinx communities. Certainly, we know that race is a social construct, and until we can get more data in these populations about genetics and ancestry, certainly it is likely that social determinants of health, access to care, and other things may be playing a role, or environmental factors that have yet to be identified in why we're seeing some of these differences.

What are next steps for the CHIMES trial?

The findings in terms of efficacy were largely in line with what we expected to see. There was a surprise that many of the patients did come to diagnosis pretty early on after onset of symptoms. One of the reasons that has been hypothesized for why we see more severe disease in these populations has been because there's delayed diagnosis—but we really didn't see that in the CHIMES trial. So that was a surprising finding.

I think the next steps are to continue to analyze the data. We would love to have the continued retention for the full 4 years of this study, with the 3 years of extension. And to understand the genomics and ancestry, I think, will be a huge piece of this, as well as B-cell markers and biomarkers.

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