At-Risk Populations | NMOSD HCP Website

Considering key disparities may aid in diagnosing NMOSD sooner and improving patients’ prognosEs

IN A REVIEW STUDY

Female to male ratio⁴^*

IN ANOTHER

NMOSD was shown to be more common in people of African or Asian ancestry as compared to people with Caucasian ancestry ^5†

^*Based on a review of 19 studies reporting crude and adjusted prevalence estimates for NMOSD overall, as well as by region and ancestry.⁴

^†Based on a systematic search of 33 epidemiologic studies in NMO/NMOSD published from 1999 to August 2019.⁵

Patients of African ancestry ARE MORE LIKELY TO HAVE A SEVERE ATTACK AT ONSET THAN PATIENTS OF CAUCASIAN ANCESTRY^6‡

Severe attack at onset⁶

African Ancestry
(n=92)

ASIAN Ancestry
(n=304)

CAUCASIAN Ancestry
(n=207)

^‡A retrospective review of 603 patients with anti-AQP4 antibody-positive NMOSD identified from 2006 to 2017 from 6 treatment centers across Denmark, Germany, South Korea, United Kingdom, United States, and Thailand.

Mortality rates are higher for patients of African ancestry vs all other ANCESTRIES^1§

MORTALITY

15.4%

AFRICAN ANCESTRY

OVERALL MORTALITY

The mortality rate among those of African ancestry was 15.4% (27/175) compared to the overall mortality rate of 7% (30/427) (P <0.0001).^1§

DEATHS

90%

AFRICAN ANCESTRY

10%

ALL OTHER ETHNICITIES

While patients of African ancestry made up 41% (175/427) of the NMOSD population, they accounted for 90% (27/30) of deaths (P<0.0001).^1§

The average age of death was younger in patients of African ancestry than those of Caucasian ancestry (50 vs 67 years old).¹

^§From a retrospective study of 427 patients with NMOSD, as defined by the 2015 International Panel for NMO Diagnosis, seen at Johns Hopkins Hospital and New York University.¹

Testing for NMOSD as soon as clinical characteristics are present is crucial^1,6,7

The mean age of NMOSD onset varies across racial and ethnic groups but can appear much earlier in patients of African and Asian ancestry.^6||

African ancestry

33 years

Asian ancestry

36 years

Caucasian ancestry

44 years

To help identify NMOSD, a full diagnostic workup should include the following⁸:

Complete medical history and physical exam⁸
Cell-based assay to test for anti-AQP4 antibodies⁷
Electrophysiological analysis⁸
Imaging studies⁸

^||From a retrospective review of 603 patients with anti-AQP4 antibody-positive NMOSD identified from 2006 to 2017 from 6 treatment centers across Denmark, Germany, South Korea, United Kingdom, United States, and Thailand.⁶

Some common misconceptions may delay diagnosis for at-risk populations. Recognizing and acknowledging your patients’ symptoms may help overcome historical myths, including:

People of color have a higher pain tolerance^3¶
Women tend to overreport their symptoms^9#

^¶From 2 survey-based studies to assess the racial bias in pain assessment, treatment recommendations, and false beliefs about biological differences between blacks and whites. Study 1 had 92 participants and Study 2 had 222 participants.³

^#From 2 surveys based on initial and larger preregistered replication studies to assess bias in the pain reporting behavior among different populations. Study 1 had 92 participants and Study 2 had 248 participants.⁹

Download academic articles

Read peer-reviewed publications that suggest age and race may play a significant role in clinical features and disease severity.

Caucasian and African women were ~2 to 8 times more likely to develop NMOSD than male patients⁵^**

^**Based on a systematic search of 33 epidemiologic studies in NMO/NMOSD published from 1999 to August 2019.⁵

Download Neuromyelitis optica worldwide prevalence and incidence study

From Worldwide Incidence and Prevalence of Neuromyelitis Optica: A Systematic Review

Papp V, et al.Neurology. 2021;96(2):59-77.

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African and Asian patients had a younger disease onset than Caucasian patients²^††

^††Based on a review of population-based prevalence and incidence studies of NMOSD from January 2000 to March 2020.²

Download neuromyelitis optica spectrum disorder epidemiology study

From Epidemiology of Neuromyelitis Optica Spectrum Disorder and Its Prevalence and Incidence Worldwide

Hor JY, et al. Front Neurol. 2020;11:501.

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Patients of African and Asian ancestry had a higher frequency of severe attacks at disease onset compared to Caucasian patients⁶^‡‡

^‡‡From a 2006 to 2017 retrospective study of a large international cohort of 6 neurology departments, which included 603 patients with anti-AQP4-IgG+ NMOSD.⁶

Download Racial differences in neuromyelitis optica spectrum disorder study

From Racial Differences in Neuromyelitis Optica Spectrum Disorder

Kim SH, et al. Neurology. 2018;91(22):e2089-e2099.

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NMOSD patients of African ancestry had a 2x higher mortality rate than the overall NMOSD group¹^§§

^§§From a retrospective study of 427 patients with NMOSD seen at 2 large US-based clinics (328 from Johns Hopkins Hospital and 99 from New York University).¹

Download Mortality in neuromyelitis optica association with African ancestry study

From Mortality in Neuromyelitis Optica Is Strongly Associated With African Ancestry

Mealy MA, et al. Neurol Neuroimmunol Neuroinflamm. 2018;5(4):e468.

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References: 1. Mealy MA, Kessler RA,
Rimler Z, et al. Mortality in neuromyelitis optica is strongly associated with African ancestry. Neurol Neuroimmunol Neuroinflamm. 2018;5(4): e468. 2. Hor JY, Asgari N, Nakashima I, et al. Epidemiology
of neuromyelitis optica spectrum disorder
and its prevalence and incidence worldwide. Front Neurol. 2020;11:501. 3. Hoffman
KM, Trawalter S, Axt JR, Oliver MN. Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites. Proc Natl Acad Sci USA.
2016;113(16):4296-4301. 4. Bukhari W, Prain KM, Waters P, et al. Incidence and prevalence of NMOSD in Australia and New Zealand. J Neurol Neurosurg Psychiatry. 2017;88(8):632-638. 5. Papp V, Magyari
M, Aktas O, et al. Worldwide incidence and prevalence of neuromyelitis optica: a systematic review. Neurology. 2021;96(2):59-77. 6. Kim S-H. Mealy MA, Levy M, et al. Racial differences in neuromyelitis optica spectrum disorder. Neurology. 2018;91(22):e2089-e2099. 7. Wingerchuk DM, Banwell B, Bennett JL, et
al. International consensus diagnostic
criteria for neuromyelitis optica spectrum disorders. Neurology. 2015;85(2):177-189. 8. Trebst C, Jarius S, Berthele A, et al. Update on the diagnosis and treatment of neuromyelitis optica: recommendations of
the Neuromyelitis Optica Study Group (NEMOS). J Neurol. 2014;261(1):1-16. 9. Boring BL, Ng BW, Nanavaty N, Mathur VA. Over-rating pain is overrated: a fundamental self-other bias in pain reporting behavior. J Pain. 2022;23(10):1779-1789. 10. Jarius S, Ruprecht K, Wildemann B, et al. Contrasting disease patterns in seropositive and seronegative neuromyelitis optica: a multicentre study of 175 patients. J Neuroinflammation. 2012;9:14. 11. Kitley
J, Leite MI, Nakashima I, et al. Prognostic factors and disease course in aquaporin-4 antibody-
positive patients with
neuromyelitis optica spectrum disorder from the United Kingdom and Japan. Brain. 2012;135(pt 6):1834-1849.

NMOSD can disproportionately affect some patient populations ^1,2

Considering key disparities may aid in diagnosing NMOSD sooner and improving patients’ prognosEs

IN A REVIEW STUDY

IN ANOTHER

Patients of African ancestry ARE MORE LIKELY TO HAVE A SEVERE ATTACK AT ONSET THAN PATIENTS OF CAUCASIAN ANCESTRY^6‡

Severe attack at onset⁶

Mortality rates are higher for patients of African ancestry vs all other ANCESTRIES^1§

MORTALITY

DEATHS

Testing for NMOSD as soon as clinical characteristics are present is crucial^1,6,7

AN ACCURATE DIAGNOSIS IS CRITICAL FOR THESE PATIENTS

Download academic articles

ATTACKS CAN BE RECURRENT AND MAY PREDICT FUTURE DISABILITY^10,11

ADDRESSING DISPARITIES
IN CARE

NMOSD can disproportionately affect some patient populations 1,2

Considering key disparities may aid in diagnosing NMOSD sooner and improving patients’ prognosEs

IN A REVIEW STUDY

IN ANOTHER

Patients of African ancestry ARE MORE LIKELY TO HAVE A SEVERE ATTACK AT ONSET THAN PATIENTS OF CAUCASIAN ANCESTRY6‡

Severe attack at onset6

Mortality rates are higher for patients of African ancestry vs all other ANCESTRIES1§

MORTALITY

DEATHS

Testing for NMOSD as soon as clinical characteristics are present is crucial1,6,7

AN ACCURATE DIAGNOSIS IS CRITICAL FOR THESE PATIENTS

Download academic articles

ATTACKS CAN BE RECURRENT AND MAY PREDICT FUTURE DISABILITY10,11

ADDRESSING DISPARITIES IN CARE

Stay In The Know

NMOSD can disproportionately affect some patient populations ^1,2

Patients of African ancestry ARE MORE LIKELY TO HAVE A SEVERE ATTACK AT ONSET THAN PATIENTS OF CAUCASIAN ANCESTRY^6‡

Severe attack at onset⁶

Mortality rates are higher for patients of African ancestry vs all other ANCESTRIES^1§

Testing for NMOSD as soon as clinical characteristics are present is crucial^1,6,7

ATTACKS CAN BE RECURRENT AND MAY PREDICT FUTURE DISABILITY^10,11

ADDRESSING DISPARITIES
IN CARE