Disease Modifying Therapies Improve Prognosis in Patients with Pediatric-Onset Multiple Sclerosis

The risk of reaching persistent disability in patients with pediatric-onset multiple sclerosis (MS) has seen a significant reduction amidst increases of approved disease modifying therapies (DMT) before age 18, which will continue to improve future prognosis of patients, according to recent findings published in JAMA Neurology.

“So far, in adult MS, the risk of reaching a persistent disability is gradually decreasing over time; however, this finding has not yet been demonstrated in the POMS (pediatric-onset multiple sclerosis) population, whose management is limited by a low number of approved DMTs before age 18 years and possibly by other factors,” wrote Damiano Baroncini, MD, Multiple Sclerosis Center, Gallarate Hospital, ASST Valle Olona, Gallarate (VA), Italy, and co-researchers. These factors may include “frequent cognitive impairment, involvement of the family in therapeutic decisions, and risk of low adherence to therapies.”

Researchers aimed to evaluate changes in prognosis of patients with pediatric-onset MS over time in association with changing  DMTs and disease management through this retrospective, multicenter, observational study.

A total of 3,198 patients from an Italian MS Registry with MS onset at age 18 or younger, diagnosis before January 2014, and a disease duration of 3 years or more were ultimately analyzed in this study.

The median age of these patients was 15.2 years at onset. An analysis of the data showed the risk of reaching disability milestones decreased over time based on the Expanded Disability Status Scale (EDSS). Median survival times to reach an EDSS score of 4.0 and 6.0 were 31.7 and 40.5 years, respectively.

Researchers concluded that the risk of persistent disability in patients with pediatric-onset multiple sclerosis has decreased by 50% to 70% in recent diagnosis epochs, due to an increase disease modifying therapies and improved managing standards.

“In recent diagnosis epochs, patients with POMS started earlier and continued taking DMTs longer compared with the past,” Dr. Baroncini, et al wrote. “Based on these results, our hypothesis is that improvement of POMS prognosis probably depends on changing therapeutic standards in MS.”

—Erin McGuinness

Baroncini, D., Simone, M., Iaffaldano, P., Brescia Morra, V., Lanzillo, R., Filippi, M., Romeo, M., Patti, F., Chisari, C. G., Cocco, E., Fenu, G., Salemi, G., Ragonese, P., Inglese, M., Cellerino, M., Margari, L., Comi, G., Zaffaroni, M., Ghezzi, A., & Italian MS registry (2021). Risk of Persistent Disability in Patients with Pediatric-Onset Multiple Sclerosis. JAMA neurology, 10.1001/jamaneurol.2021.1008. Advance online publication. https://doi.org/10.1001/jamaneurol.2021.1008