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Inadequacy of Clinical Trial Designs and Data to Control for the Confounding Impact of Race/Ethnicity in Response to Treatment in Multiple Sclerosis ONLINE FIRST

Jagannadha Avasarala, MD, PhD1
[+] Author Affiliations
1Cape Neurology Specialists, St Francis Medical Center, Cape Girardeau, Missouri
JAMA Neurol. Published online June 09, 2014. doi:10.1001/jamaneurol.2014.79
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Multiple sclerosis (MS) is an autoimmune demyelinating disease characterized by a complex mix of genetics and gene-environment interactions. As compared with white Americans, African Americans are thought to have a lower risk for developing MS but a greater risk of disability and more opticospinal MS. Data show that MS in African Americans follows a more severe course than in white Americans. The 6-tiered multiple sclerosis severity scale–based analysis demonstrates that African ancestry is a risk factor for a more rapidly disabling disease course.1 While MS is rare in native Africans, it can be associated with a higher risk of cane dependency, a shorter time to cane, and a shorter duration from symptom onset to diagnosis.2 In one study, African American patients with MS admitted to US nursing homes were 6 years younger than white American patients with MS on admission, but more disabled.3

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