Achieving Equitable MS Outcomes Through Algorithmic Treatment Pathways
Kaiser Permanente Southern California implemented the Multiple Sclerosis Treatment Optimization Program (MSTOP) in 2012 to address disparities in MS treatment outcomes among Black, Hispanic, and White patients. The program introduced a treatment algorithm that aligns disease-modifying therapies (DMTs) with a patient’s disability risk while accounting for social determinants of health (SDOH) without explicitly considering race or ethnicity to reduce unconscious bias. The algorithm primarily recommended rituximab, a highly efficacious treatment (HET) with a favorable cost-effectiveness profile.
A recent study published in Neurology analyzed the impact of MSTOP on DMT utilization and annual relapse rates (ARRs) among 6119 patients treated between 2009 and 2023. Before the program's implementation, Hispanic patients experienced significantly higher ARRs than their White counterparts, while Black patients also faced higher ARRs during the early implementation period. Despite the disparities in outcomes, HET use remained low and relatively uniform across racial and ethnic groups.
Following the implementation of MSTOP, HET use increased markedly across all groups, with rituximab emerging as the predominant therapy. By 2023, HET use had risen to 89.3% among Hispanic patients, 87.4% among Black patients, and 82.9% among White patients. Correspondingly, the ARR declined by 90% among Hispanic patients, 82% among Black patients, and 86% among White patients, effectively eliminating the clinically significant disparities in relapse rates observed before the intervention.
The study underscores the potential of algorithmic treatment strategies to achieve equitable outcomes without explicitly referencing race or ethnicity. By focusing on risk stratification and addressing SDOH, MSTOP successfully increased access to HETs and reduced relapse rates in a diverse patient population. This approach may serve as a model for other health systems seeking to mitigate disparities in chronic disease management through systematic, equity-focused interventions.
Despite these promising results, some disparities in treatment outcomes remain. Black patients, while experiencing substantial declines in ARR, did not achieve the same level of improvement as Hispanic or White patients, suggesting that additional targeted interventions may be necessary to further reduce inequities in MS care.
Reference
Langer-Gould A, Li BH, Smith JB, Kanter MH, Choi KR, Xu S. Racial inequities, multiple sclerosis, and implementation of a novel treatment algorithm at the health system level. Neurology. 2025;104(10):e213607. doi:10.1212/WNL.0000000000213607
