What does first-line therapy mean for paediatric multiple sclerosis in the current era?

Area of Science:

• Neurology
• Pediatric Neurology
• Neuroimmunology

Background:

• Pediatric multiple sclerosis (MS) presents with aggressive disease characteristics, including higher relapse rates and faster lesion accumulation.
• Long-term outcomes in pediatric MS are often worse, with significant cognitive and physical disability.
• Current treatment guidelines for pediatric MS are often adapted from adult protocols and lack specificity.

Purpose of the Study:

• To review first-line treatment options for pediatric MS.
• To evaluate the suitability of injectable disease-modifying therapies (DMTs) as a first-line option for pediatric MS.
• To provide recommendations for optimizing treatment strategies in pediatric MS.

Main Methods:

• Literature review focusing on the clinical course and outcomes of early-onset MS.
• Analysis of the risks and benefits of various treatment options for pediatric MS.
• Comparative assessment of injectable DMTs versus highly effective DMTs in the context of pediatric MS.

Main Results:

• Pediatric MS exhibits a more severe disease course compared to adult-onset MS.
• Early disease activity significantly impacts cognitive function, brain atrophy, and the development of progressive MS.
• Injectable DMTs may not be the optimal first-line choice for managing aggressive pediatric MS.

Conclusions:

• Pediatric MS should be considered a highly active disease requiring aggressive management.
• Early initiation of highly effective disease-modifying therapies (DMTs) is recommended for pediatric MS.
• A shift towards more potent DMTs early in the disease course is advocated to improve long-term outcomes.