Author Of 2 Presentations
LB1179 - Predictors of Disease Modifying Treatment Failure Amongst Neuromyelitis Optica Spectrum Disorder Patients, Stratified by Antibody Serostatus (ID 1947)
Abstract
Background
Neuromyelitis Optica Spectrum Disorder (NMOSD) is a rare autoimmune disease characterized by demyelination and axonal injury of the central nervous system. Serologic classification for aquaporin-4 immunoglobulin G (AQP4-IgG) and myelin oligodendrocyte glycoprotein immunoglobulin G (MOG-IgG) can be useful and have been associated with diverse outcomes.
Objectives
To characterize NMOSD stratified by antibody serostatus (AQP4-IgG antibody positive, MOG-IgG antibody negative, and APQ4-IgG/MOG-IgG double negative) and evaluate predictors of disability outcomes.
Methods
This was a retrospective, single center study of 75 patients meeting NMOSD 2015 criteria who are seen and followed at a single center. AQP4-IgG and MOG-IgG antibodies were tested. The relationship between antibody status (AQP4-IgG+, MOG-IgG+) and double seronegative (DNeg) and DMT failure and Expanded Disability Status Scale (EDSS) was tested using multivariate linear regression (adjusted for age of onset, sex, race/ethnicity). DMT failure was defined as having to switch due to breakthrough disease on current DMT.
Results
Most were female (76.7%), Hispanic (62.7%), with a median age of onset of 39.0 (SD±13.9) and disease duration of 8.0 (SD±7.5). More than 2/3 (69%) were on rituximab. Presentation with optic neuritis or myelitis varied by seropositive types (P-value<0.05). APQ4-IgG+ presented more likely with optic neuritis (44.5%) while DNeg were more likely to present with myelitis (87%). Disability also differed significantly between the groups (p-value<0.05). About 40% of AQP4IgG+ and DNeg patients had EDSS>=4 while all MOG-IgG patients had EDSS<4. Greater odds of DMT failure was observed with being MOG-IgG+ (OR 2.9 95% CI 0.86-10.22) compared to AQP4-IgG+. After controlling for age, sex, age at onset and DMT failure, MOG-IgG+ patients had lower disability (mean EDSS:1.6, p-value<0.01) compared to AQP4-IgG+ and DNeg patients (mean EDSS:3.6).
Conclusions
In this predominant Hispanic sample of NMOSD, we confirm that MOG-IgG+ serostatus is an important biomarker of treatment failure. Treatment approaches specific to NMOSD MOG-IgG+ are warranted.
P0428 - Acculturation and lower socioeconomic status are associated with early disability in Hispanic/Latinx with Multiple Sclerosis. (ID 1494)
Abstract
Background
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.
Objectives
To examine the association of sociodemographic and acculturation measures in early MS disability in Hispanic/Latinx (Latinx).
Methods
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.
Results
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.
Conclusions
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.