Abstract Details

Title Neighborhood Disadvantage is Not Associated with Exposure to NMOSD Treatment

Topic Autoimmune Neurology

Presentation(s) P11 - Poster Session 11 (8:00 AM-9:00 AM)

Poster/Presentation
Number 8-009

Objective To assess whether neighborhood-level disadvantage is associated with time to initiation of an immunosuppressive therapy (IST) among persons with neuromyelitis optica spectrum disorder (pwNMOSD).

Background Little is known about the relationship between neighborhood-level disadvantage and exposure to NMOSD-specific IST.

Design/Methods This is a retrospective cohort study of patients with aquaporin-4 (AQP4)-positive NMOSD diagnosed after the first FDA approved NMOSD-specific IST became available (eculizumab, January 2019). We created four multivariable cox proportional hazards regression models to evaluate whether time from NMOSD diagnosis to first exposure to an NMOSD-specific IST (rituximab, satralizumab, inebilizumab, or eculizumab) was associated with neighborhood disadvantage. Neighborhood disadvantage (yes or no) was defined as being in the most disadvantaged 15% of Americans in terms of financial strength, educational attainment, economic hardship/inequality, or overall area deprivation index (ADI). We adjusted for race, insurance, and education level.

Results We included 38 AQP4-positive NMOSD participants: mean age at diagnosis was 47.6±18.8 years, 82.0% female, 49.0% non-White who were followed for a mean of 1.3±1.1 years since diagnosis. During follow-up for this study, 25 (65.9%) of 38 participants were exposed to an NMOSD-specific IST. Participants who initiated an NMOSD-specific IST did not differ from those who did not in terms of insurance, race, rural-urban commuting area codes, or ADI (p>0.05 for all). Time from NMOSD diagnosis to initiation of an NMOSD-specific IST did not associate with neighborhood disadvantage, including financial strength (hazard ratio (HR) 0.23, p=0.21), educational attainment (HR 2.76, p=0.18), economic hardship/inequality (HR 0.37, p=0.26), or overall deprivation (HR 0.33, p=0.27).

Conclusions Neighborhood disadvantage did not associate with likelihood of exposure or time to initiation of an NMOSD-specific IST, suggesting that disadvantage was not a barrier to treatment in our small cohort. Notably, one-third of pwNMOSD were never exposed to an NMOSD-specific IST, regardless of disadvantage, which warrants further investigation.

Authors/Disclosures
Kaitlyn Palmer, MD PRESENTER	Dr. Palmer has nothing to disclose.
Devon Conway, MD	Dr. Conway has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Bristol Myers Squibb. Dr. Conway has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Alexion. Dr. Conway has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Genentech. Dr. Conway has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Amgen. Dr. Conway has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Biogen. Dr. Conway has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Biogen. The institution of Dr. Conway has received research support from Novartis. The institution of Dr. Conway has received research support from BMS. The institution of Dr. Conway has received research support from Biogen.
Mengke Du (Cleveland Clinic)	Mengke Du has nothing to disclose.
Albert Aboseif, DO (Mayo Clinic Rochester)	Dr. Aboseif has received research support from the Eugene & Marcia Applebaum Fellowship Grant.
Carol Swetlik, MD (Cleveland Clinic)	An immediate family member of Dr. Swetlik has received personal compensation for serving as an employee of Pfizer. Dr. Swetlik has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genetech. Dr. Swetlik has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Amgen.
Julie Widmar, NP	Ms. Widmar has received personal compensation for serving as an employee of Amgen .
Amy Kunchok, MBBS (Cleveland Clinic - Mellen Centre)	Dr. Kunchok has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Neurology:Open Access Journal .
Deborah M. Miller, PhD (Cleveland Clinic Foundation)	Dr. Miller has received intellectual property interests from a discovery or technology relating to health care.
Julia O'Mahony (The Hospital for Sick Children)	Ms. O'Mahony has nothing to disclose.
Justin Abbatemarco, MD	Dr. Abbatemarco has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for EMD Serono. Dr. Abbatemarco has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Horizon. Dr. Abbatemarco has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech . Dr. Abbatemarco has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for TG Therapeutics, Inc.. Dr. Abbatemarco has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Amgen. The institution of Dr. Abbatemarco has received research support from Amgen.

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