Key result
Multiple sclerosis patients of Middle Eastern and North African descent showed greater disability progression over time compared to European descent patients.
Why the study?
Multiple sclerosis incidence is rising in traditionally low-burden regions, including the Middle East and North Africa, prompting evaluation of disease characteristics in patients of this ancestry.
Do MS patients of Middle Eastern and North African descent have different disease severity and activity compared to patients of European descent?
Cohort (n=384)
No
Do MS patients of Middle Eastern and North African descent have different disease severity and activity compared to patients of European descent?
Multiple sclerosis patients of Middle Eastern and North African descent residing in Canada demonstrate higher disease severity and disability progression compared to those of European descent, despite similar inflammatory disease activity.
Answers are grounded in this paper and cite their sources.
No immediate ancestry-based changes to MS care warranted; leaves open validation of progression disparities in prospective studies.
Background: Multiple sclerosis (MS) incidence is rising in traditionally low-burden regions, including the Middle East and North Africa (MENA). Objectives: Our objective was to evaluate disease characteristics in MS patients of MENA descent (MENA-MS). Methods: MENA-MS patients and age- and sex-matched MS patients of European descent (EUR-MS) were identified through the MS Clinic Registry of St. Michael’s Hospital in Toronto, Canada. Disease activity and severity were evaluated by the annualized relapse rate (ARR), magnetic resonance imaging (MRI) activity, change in the Expanded Disability Status Scale (EDSS), progression index (PI), and MS Severity Score (MSSS). Results: All MS patients within the registry identified to be of MENA origin ( n = 192), and age- and sex-matched EUR-MS patients were included. Mean age was 42.9 years, 67% female. A total of 25% and 24% of EUR-MS and MENA-MS had progressive disease, with similar mean disease durations (11.5 and 11.4 years, respectively). Clinical and radiological disease activity (ARR, proportion with new/enlarging MRI lesions) was similar. MENA-MS showed greater disability progression over time (EDSS change = 0.24 vs. 0.06, p = 0.01), a higher MSSS (3.12 vs. 2.67, p = 0.04), and higher PI (0.34 vs. 0.27, p = 0.07). Conclusion: MENA-MS patients demonstrate higher disease severity compared to EUR-MS patients, despite having similar inflammatory measures of disease activity, with disability progression in the absence of relapses. These observations illustrate the importance of the intersections of environmental, socioeconomic, and genetic determinants in optimizing individualized MS care.
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Seyman et al. (2020) conducted a cohort in Multiple sclerosis (n=384). Middle Eastern and North African (MENA) descent vs. European descent was evaluated on Change in the Expanded Disability Status Scale (EDSS) (p=0.01). Multiple sclerosis patients of Middle Eastern and North African descent showed greater disability progression over time compared to European descent patients.
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