Use of Disease-Modifying Therapies in Pediatric Relapsing-Remitting Multiple Sclerosis in the United Kingdom

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Omar A Abdel-Mannan1, Celeste Manchoon1, Thomas Rossor1

  • 1From the Queen Square MS Centre (O.A.A., W.B., O.C., C.H., Y.H.), UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London; Department of Neurology (O.A.A., O.C., C.H., Y.H.), Great Ormond Street Hospital for Children, London; Children's Neurosciences (C.M.), Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation; Department of Paediatric Neurology (T.R., M.C.), Addenbrooke's Hospital, Cambridge; Department of Neurology (J.-C.S., R.K.), Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom; Queen Square Institute of Neurology (C.T.), Faculty of Brain Sciences, University College London; Multiple Sclerosis Centre of Catalonia (Cemcat) (C.T.), Vall d'Hebron Institute of Research, Vall d'Hebron Barcelona Hospital Campus, Spain; Children's Neurosciences (S.B.), Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, King's Health Partners Academic Health Science Centre, London; Department of Clinical Neurosciences (A.C.), Addenbrooke's Hospital, Cambridge; Translational and Clinical Research Institute (R.F.), Newcastle University; Department of Neuroradiology (K.M.), Great Ormond Street Hospital for Children, London; Department of Neurology (D.R., S. West), Royal Manchester Children's Hospital, Manchester; Department of Neurology (S. Wright, E.W.), Birmingham Children's Hospital, Birmingham; Aston Neuroscience Institute (S. Wright, E.W.), College of Health and Life Sciences, Aston University, Birmingham, United Kingdom; Evelina London Children's Hospital (M.L.), Guy's and St Thomas' NHS Foundation Trust, King's Health Partners Academic Health Science Centre, London, United Kingdom; and NIHR University College London Hospitals Biomedical Research Centre (O.C.).

Neurology(R) Neuroimmunology & Neuroinflammation
|May 22, 2021
PubMed

Insights

Newer disease-modifying therapies (DMTs) significantly reduced relapses and MRI activity in children with relapsing-remitting multiple sclerosis (RRMS) compared to older injectable treatments. This suggests a shift towards more effective DMTs for initial treatment.

Area of Science:

  • Pediatric Neurology
  • Neuroimmunology
  • Clinical Therapeutics

Background:

  • Relapsing-remitting multiple sclerosis (RRMS) in children requires effective disease-modifying therapies (DMTs).
  • Injectable DMTs have been a standard treatment, but newer oral and infusion therapies offer potential advantages.

Purpose of the Study:

  • To compare the real-world effectiveness of newer DMTs versus traditional injectable therapies in pediatric RRMS patients.
  • To evaluate clinical relapse rates, MRI activity, and disability progression between different DMT classes.

Main Methods:

  • Retrospective, multicenter study of 103 children with RRMS from the UK Childhood Inflammatory Demyelination Network (2012-2018).
  • Analysis of annualized relapse rates (ARRs), time to relapse, new MRI lesions, and Expanded Disability Status Scale (EDSS) scores.
  • Comparison of outcomes between patients on injectables (interferon beta/glatiramer acetate) and newer DMTs (oral or infusions).

Main Results:

  • Newer DMTs showed significantly lower relapse rates (15% vs 59.5%) and reduced new MRI lesions (47% vs 86.5%) compared to injectables.
  • Patients on newer DMTs experienced longer time to relapse, treatment switch, and new radiologic activity.
  • Multivariable analysis indicated injectables were associated with a 12-fold increased risk of clinical relapse and a 2-fold increased risk of new radiologic activity.

Conclusions:

  • Newer DMTs are more effective than injectables in managing pediatric RRMS, reducing both clinical and radiologic disease activity.
  • The findings support a paradigm shift towards utilizing newer, more efficacious DMTs as first-line treatment in children with RRMS.
Abstract

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