To assess the effects of DMTs on cognition, retinal integrity, fatigue, and EDSS, over 24 months in African American and non-African American patients with relapsing MS.

Disability, cognitive, visual and fatigue-related impairments are major manifestations of multiple sclerosis (MS) that accumulate more rapidly among African Americans compared to non-African Americans. Despite this, African Americans remain underrepresented in MS clinical studies. Addressing this gap is essential to advance equitable, evidence-based MS care.

This prospective, 24-month observational study evaluated African American and Non-African American patients with relapsing MS receiving DMTs. Cognition was assessed using CogEval and NeuroTrax; retinal nerve fiber layer (RNFL) and ganglion cell-inner plexiform (GCIP) thickness were measured using Optical Coherence Tomography; fatigue with the Modified Fatigue Impact Scale (MFIS); and disability using Expanded Disability Status Scale (EDSS). Longitudinal outcomes and racial differences were analyzed using linear mixed-effects models with fixed effects for race, time, and their interaction, adjusting for covariates. Time-varying factors and multiple comparison-corrected contrasts assessed within- and between-group differences.

DMT use may confer greater benefit on cognitive outcomes in African American MS patients, while maintaining retinal integrity, and fatigue in African American and non-African American MS patients, underscoring the importance of inclusive research, support treatment strategies for racial groups with MS, and suggest that DMT use can help mitigate disparities in MS outcomes.