Clinical Characteristics of Multiple Sclerosis in African-Americans

  • Veronica P. CiprianiEmail author
  • Sara Klein
Demyelinating Disorders (J. Bernard & M. Cameron, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Demyelinating Disorders


Purpose of Review

Multiple sclerosis (MS) is an autoimmune disease of the central nervous system that affects nearly 1 million people in the USA and has the potential to profoundly affect physical ability and income potential at a young age. Since a landmark paper was published in 2014, few studies have looked at differences in MS disease characteristics between African-American and Caucasian patients.

Recent Findings

African-American patients often have a more severe MS disease course, as well as biomarker data which can portend a worse prognosis. While the sample sizes are usually quite small, subgroup analyses of African-American patients have been performed to evaluate efficacy of disease-modifying treatments as compared with the entire study population, made up of primarily Caucasians.


In an era where we strive for personalized medicine, understanding racial differences in MS may help us better treat African-American patients in the future.


Multiple sclerosis African-Americans Progression Disease severity 


Compliance with Ethical Standards

Conflict of Interest

Sara Klein declares no potential conflicts of interest.

Veronica P. Cipriani has received honoraria from Biogen Idec, Genentech, EMD Serono, and Sanofi Genzyme for educational or consulting activities. She has received honoraria for speaking for Genentech.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Wallin MT, Culpepper WJ, Campbell JD, Nelson LM, Langer-Gould A, Marrie RA, et al. The prevalence of MS in the United States: a population-based estimate using health claims data. Neurology. 2019;92(10):e1029–40. Scholar
  2. 2.
    Langer-Gould A, Brara SM, Beaber BE, Zhang JL. Incidence of multiple sclerosis in multiple racial and ethnic groups. Neurology. 2013;80(19):1734–9. Scholar
  3. 3.
    Khan O, Williams MJ, Amezcua L, Javed A, Larsen KE, Smrtka JM. Multiple sclerosis in US minority populations. Neurol Clin Pract. 2015;5(2):132–42. Scholar
  4. 4.
    Kirby JB, Kaneda T. Unhealthy and uninsured: exploring racial differences in health and health insurance coverage using a life table approach. Demography. 2010;47(4):1035–51. Scholar
  5. 5.
    Comi G. Clinically isolated syndrome: the rationale for early treatment. Nat Clin Pract Neurol. 2008;4(5):234–5.CrossRefGoogle Scholar
  6. 6.
    Fabius CD, Thomas KS, Zhang T, Ogarek J, Shireman TI. Racial disparities in Medicaid home and community-based service utilization and expenditures among persons with multiple sclerosis. BMC Health Serv Res. 2018;18:773. Scholar
  7. 7.
    Corbie-Smith G, Thomas SB, St George DM. Distrust, race and research. Arch Intern Med. 2002;162(21):2458–63.CrossRefGoogle Scholar
  8. 8.
    Gamble VN. Under the shadow of Tuskegee: African Americans and health care. Am J Public Health. 1997;87(11):1773–8.CrossRefGoogle Scholar
  9. 9.
    Oksenberg JR, Barcellos LF, Cree BAC, Baranzini SE, Bugawan TL, Khan O, et al. Mapping multiple sclerosis susceptibility to the HLA-DR locus in African Americans. Am J Hum Genet. 2004;74(1):160–7.CrossRefGoogle Scholar
  10. 10.
    • Chi C, et al. Admixture mapping reveals evidence of differential multiple sclerosis risk by genetic ancestry. PLoS Genet. 2019;15(1):e1007808. The authors report that African-Americans with European haplotype MS-associated alleles conferred three times the risk of MS than those on the African haplotype. CrossRefGoogle Scholar
  11. 11.
    Isobe N, Madireddy L, Khankhanian P, Matsushita T, Caillier SJ, Moré JM, et al. An ImmunoChip study of multiple sclerosis risk in African Americans. Brain. 2015;138:1518–30. Scholar
  12. 12.
    Simpson S Jr, et al. Latitude continues to be significantly associated with prevalence of multiple sclerosis: an updated meta-analysis. J Neurol Neurosurg Psychiatry. 2019:jnnp-2018-320189. Scholar
  13. 13.
    Alter M, Kahana E, Loewenson R. Migration and risk of multiple sclerosis. Neurology. 1978;28(11):1089.CrossRefGoogle Scholar
  14. 14.
    Nielsen NM, et al. Multiple sclerosis among first- and second-generation immigrants in Denmark. Brain. 2019;142(6):1587–97. Scholar
  15. 15.
    Munger KL, Levin LI, Hollis BW, Howard NS, Ascherio A. Serum 25-hydroxyvitamin D levels and risk of multiple sclerosis. JAMA. 2006;296:2832–8.CrossRefGoogle Scholar
  16. 16.
    • Langer-Gould A, Lucus R, Xiang AH, et al. MS Sunshine study: sun exposure but not vitamin D is associated with multiple sclerosis risk in Blacks and Hispanics. Nutrients. 2018;10:268. The authors report that only white patients had a lower risk of MS with higher serum vitamin D levels. However, lifetime sun exposure reduces the risk of MS in multiple racial/ethnic groups. CrossRefGoogle Scholar
  17. 17.
    Speeckaert MM, Speeckaert R, Van Geel N, et al. Vitamin D binding protein: a multifunctional protein of clinical importance. Adv Clin Chem. 2014;61:1–57.Google Scholar
  18. 18.
    Langer-Gould A, et al. Vitamin D-binding protein polymorphisms, 25-hydroxyvitamin D, sunshine and multiple sclerosis. Nutrients. 2018;10(2):E184. Scholar
  19. 19.
    Cree BA, et al. Clinical characteristics of African Americans vs Caucasian Americans with multiple sclerosis. Neurology. 2004;63(11):2039–45.CrossRefGoogle Scholar
  20. 20.
    Guillemin F, Baumann C, Epstein J, Kerschen P, Garot T, Mathey G, et al. Older age at multiple sclerosis onset is an independent factor of poor prognosis: a population-based cohort study. Neuroepidemiology. 2017;48(3–4):179–87. Scholar
  21. 21.
    Naismith RT, Trinkaus K, Cross AH. Phenotype and prognosis in African-Americans with multiple sclerosis: a retrospective chart review. Mult Scler. 2006;12:775–81.CrossRefGoogle Scholar
  22. 22.
    Kister I, et al. Rapid disease course in African Americans with multiple sclerosis. Neurology. 2010;75(3):217–23. CrossRefPubMedGoogle Scholar
  23. 23.
    Comi G, et al. Effect of early interferon treatment on conversion to definite multiple sclerosis: a randomised study. Lancet. 2001;358(9268):1576–82.CrossRefGoogle Scholar
  24. 24.
    •• Seraji-Bozorgzad N, Khan O, Cree B, et al. Cerebral grey matter atrophy is associated with the CSF IgG index in African American with multiple sclerosis. J Neuroimaging. 2017;27:476–80. The authors report that African-American patients have a strong inverse correlation between gray matter volume and CSF IgG index, compared with Caucasian patients. This supports the role of the humoral immune system in mediating MS pathology in African-American patients. CrossRefGoogle Scholar
  25. 25.
    • Caldito NG, Saidha S, Sotirchos ES, et al. Brain and retinal atrophy in African-Americans versus Caucasian-Americans with multiple sclerosis: a longitudinal study. Brain. 2018;141(11):3115–29. This study reports an accelerated rate of neurodegeneration as seen in ganglion cell inner plexiform layer and brain atrophy rates in African-Americans. CrossRefGoogle Scholar
  26. 26.
    • Al-Kawaz EM, Morris E, Perumal JS, et al. Differential impact of multiple sclerosis on cortical and deep gray matter structures in African Americans and Caucasian Americans. J Neuroimaging. 2017;27:333–8. The authors reported race-related differences in MS brain atrophy patterns. African-American patients had cortical atrophy as compared with Caucasian patients, who had reduced thalamic volumes. CrossRefGoogle Scholar
  27. 27.
    Weinstock-Guttman B, Ramanathan M, Hashmi K, Abdelrahman N, Hojnacki D, Dwyer MG, et al. Increased tissue damage and lesion volumes in African Americans with multiple sclerosis. Neurology. 2010;74(7):538–44. Scholar
  28. 28.
    • Lichtman-Mikol S, et al. Racial differences in retinal neurodegeneration as a surrogate marker for cortical atrophy in multiple sclerosis. Mult Scler Relat Disord. 2019;31:141–7. This study showed that ganglion cell inner plexiform layer thickness is a sensitive biomarker to predict brain atrophy and clinical disability in Caucasian patients, but not in African-American patients. CrossRefGoogle Scholar
  29. 29.
    Cree BA, Al-Sabbagh A, Bennett R, Goodin D. Response to interferon beta-1a treatment in African American multiple sclerosis patients. Arch Neurol. 2005;62(11):1681–3.CrossRefGoogle Scholar
  30. 30.
    Cree BA, Stuart WH, Tornatore CS, Jeffery DR, Pace AL, Cha CH. Efficacy of natalizumab therapy in patients of African descent with relapsing multiple sclerosis: analysis of AFFIRM and SENTINEL data. Arch Neurol. 2011;68(4):464–8. Scholar
  31. 31.
    Polman CH, O'Connor PW, Havrdova E, Hutchinson M, Kappos L, Miller DH, et al. A randomized, placebo-controlled trial of natalizumab for relapsing multiple sclerosis. N Engl J Med. 2006;354(9):899–910.CrossRefGoogle Scholar
  32. 32.
    Cree BA, Han J, Pradhan A, Masterman D, Williams MJ. OPERA I/II: efficacy in African-descended patients. Poster Session presented at the 34th ECTRIMS conference; 2018 Oct 10–12; Berlin, Germany.Google Scholar
  33. 33.
    Edan G, Kappos L, Montalban X, Polman CH, Freedman MS, Hartung HP, et al. Long-term impact of interferon beta-1b in patients with CIS: 8-year follow-up of BENEFIT. J Neurol Neurosurg Psychiatry. 2014;85:1183–9.CrossRefGoogle Scholar
  34. 34.
    Avasarala J. Inadequacy of clinical trial designs and data to control for the confounding impact of race/ethnicity in response to treatment in multiple sclerosis. JAMA Neurol. 2014;71(9):943–4. Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.The University of ChicagoChicagoUSA

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