Table 1_Racial and ethnic disparities in disease-modifying therapy use among adults with multiple sclerosis: a real-world analysis of the All of Us Research Program.docx

Black patients had the highest within-group initiation rate (49.2%) but the longest median time to first DMT (1,497 days vs. 1,217 days in White patients). High-efficacy DMT exposure ranged from 11.9 to 24.0% across race–sex strata, and 76.3% of assessable initiators met the 180-day discontinuation threshold (range 71.7–80.5%).</p>Discussion<p>Most patients with MS in this national cohort never initiated DMT. Hispanic patients showed the lowest initiation rates, while Black patients experienced the longest delays to treatment.

The two groups’ patterns are consistent with mechanistically distinct barriers, possible limited system entry for Hispanic patients and possible delayed specialty access for Black patients. High-efficacy DMT utilization remained low across all groups. Equitable and timely access to DMT, including high-efficacy agents, is urgently needed to reduce long-term disability across all populations.</p>