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Black race is an independent risk factor for disability in neuromyelitis optica spectrum disorder
Author(s): ,
L. Amezcua
Affiliations:
USC, Neurology, University of Southern California, Los Angeles, CA
,
L. Cook
Affiliations:
University of Utah School of Medicine, Salt Lake, UT
,
M. Yeaman
Affiliations:
UCLA, Los Angeles, CA
,
I. Kister
Affiliations:
New York University, New York, NY
M. Levy
Affiliations:
Johns Hopkins School of Medicine, Baltimore, MD, United States
ECTRIMS Online Library. Amezcua L. Oct 12, 2018; 228162
Lilyana Amezcua
Lilyana Amezcua
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Abstract: P1784

Type: Poster Sessions

Abstract Category: N/A

Objective: To evaluate race as a risk factor for disability in Neuromyelitis Optica Spectrum Disorder (NMOSD).
Methods: This is a retrospective study performed in context of the multi-ethnic, multi-center Collaborative International Research in Clinical & Longitudinal Experience Study (CIRCLES) of NMOSD patients. Inclusion criteria for analysis were diagnosis of NMOSD per the 2006 Wingerchuk or 2015 International Panel for Neuromyelitis Optica Diagnosis (IPND) guidelines. Race was self-reported in data elements collected at standardized clinical study visits. Clinical demographic and therapeutic information were extracted from medical records using a standardized intake form. Disability was assessed as ambulatory ability and visual acuity. Comparisons among study cohorts were statistically analyzed using Fisher's exact test or Chi-square.
Results: 553 NMOSD patients met inclusion criteria for this study, 54% of whom were white, 26% black, 12% Latino, and 8% Asian. Age at symptom onset was younger for black age (Mean [Range] 36.7 [26.4, 45.7] and Latino 36.7 [26.4, 45.7] as compared to whites (40.9 [31.2, 53.2]; p< 0.001). Black patients were the most likely of the racial groups to be partially or completely dependent on others for mobility (p=0.0013). A higher proportion of black were more likely to be legally blind in one or both eyes (47.3%) compared to whites (23.8%; p< 0.001). No significant differences to access to care and exposure to immunotherapy such as rituximab, plasmapheresis and immunoglobulin were observed among the groups.
Conclusions: In the CIRCLES cohort, black race is associated with higher disability in NMOSD. This result appears to be independent of access to care and immunotherapy. The reasons for this racial disparity in disability are unknown, but similar results were observed in some, but not all observational studies of NMOSD. Contributing factors may include both genetic and environmental factors and factors related to social determinants of health not yet assessed that may impact disease severity. Understanding immunobiological factors that underlie the observed differences in outcomes will lead to better understanding of disease pathogenesis.
Disclosure: All authors receive funding or are involved with the Guthy-Jackson Charitable Foundation.

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