Author Of 2 Presentations
P0428 - Acculturation and lower socioeconomic status are associated with early disability in Hispanic/Latinx with Multiple Sclerosis. (ID 1494)
Acculturation and socioeconomic (SES) factors are known to play a large role in racial and ethnic health disparities in the United States (US). Lower SES has been reported to increase the risk of disability progression in multiple sclerosis (MS) in whites. How these measures relate to early MS in vulnerable US populations is not known. This is being evaluated as part of GAHMS, a prospective longitudinal study of Genetic ancestry and Acculturation in Hispanic background with early MS.
To examine the association of sociodemographic and acculturation measures in early MS disability in Hispanic/Latinx (Latinx).
Cross-sectional assessment of 219 self-identified US Latinx, including Puerto Rico. Early MS was defined as a diagnosis of <5 years. Sociodemographic status (SES) markers (education, household income, public assistance) and acculturation measures including language preference, place of birth, years in the US and Short Acculturation Scale for Hispanics (SASH; a composite measure of acculturation to US) were collected as part of the baseline examination. Bivariate correlations assessed SASH correlation with acculturation proxies. Unadjusted and adjusted multivariable logistic and linear regression were used to examine the relationship between ambulatory disability (using the Expanded Disability Status Scale; EDSS) and acculturation and SES.
Most participants were female (75.8%), had a mean age of onset of 30.65 years (SD±13.93), had relapsing remitting MS (85.3%), and self-identified as Latinx with Caribbean (46.3%) or Mexican origin (37.8%). Most were overweight (BMI Mean: 28.9±8.04) and unemployment was reported by 35%. A strong correlation was seen between SASH and language preference (0.75, <0.0001) and place of birth (0.70, <0.0001). Increased odds of severe ambulatory disability was associated: with being male, longer disease duration, education of high school or less (3.90, 95%CI 0.33-45.65), household income <$60,000 (3.22, 95%CI 0.26-39.75), and acculturation to US culture (4.041, 95%CI 0.79-20.62) after adjustment. EDSS also increased with acculturation to US (Beta 0.53, p=0.05) and low income (Beta 0.80, p=0.02) using adjusted linear regression.
Our study reveals insights into early disability patterns among diverse Latinx heritage, in the context of SES and cultural integration differences defined by strong acculturation measures. Preservation of Latinx cultural heritage in the US could have the capacity to alter disease severity and be protective in Latinx with MS. Further sociocultural investigations are warranted.
P0686 - Aquaporin-4 antibody seroreversion in patients with neuromyelitis optica spectrum disorder treated with rituximab. (ID 1883)
The mechanism of action (MOA) of anti B-cell therapies in CNS demyelinating disorders associated with Aquaporin-4 antibody (AQP4-Ab) neuromyelitis optica spectrum disorders (NMOSD) is unknown. Restoration of immune tolerance by blocking self-antigen presentation by autoreactive B to T cells and return to immune homeostasis has been postulated as a MOA.
Presence of AQP4-Ab is a marker of breakdown of immune tolerance in NMOSD while their disappearance after initial positivity could signify restoration of immune homeostasis. The outcome of AQP4-Ab in NMOSD treated with rituximab has not previously been examined.
To examine the evolution of AQP4-Ab status in a cohort of patients with CNS demyelinating disorders that were treated with rituximab.
Retrospective study of consecutive patients with recurrent optic neuritis or transverse myelitis treated with rituximab between 2006 and 2020. The data on AQP4-Ab status were obtained by chart review.
A total of 51 patients who were on long-term monotherapy with rituximab 1 gm IV every 6 months were identified. All were clinically stable. All serology was obtained by commercial laboratories as reported in the respective clinical records. Twenty-nine patients were AQP4-Ab positive (57%) at some time using the ELISA or more recently, the cell-based assay. In 23 patients re-testing for serological status was undertaken at varied intervals. Serostatus changed in 10 patients with 4 patients previously seronegative now becoming seropositive, and 6 patients who were seropositive becoming seronegative. In some subjects where seroreversion occurred, when titers were reported, a decrease in titer over time occurred before becoming seronegative.
AQP4-Ab reactive status can revert to non-reactivity on rituximab therapy in some patients. The seroconversion, however, was not a marker for response to rituximab as a favorable clinical response was also observed in persistently seropositive patients as well. This previously unrecognized observation suggests that the change in AQP4-Ab status from positive to negative on rituximab therapy can be used as a potential marker to guide future randomized discontinuation trials of rituximab in a select group of clinically stable patients.