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Rituximab treatment in pediatric-onset multiple sclerosis

Markus Breu1, Fredrik Sandesjö2, Ruxandra-Iulia Milos3

  • 1Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria.

European Journal of Neurology
|February 20, 2024
PubMed

Insights

Rituximab (RTX) significantly reduced relapses and MRI lesions in pediatric multiple sclerosis patients. Most patients achieved no evidence of disease activity, though adverse events were common.

Area of Science:

  • Neurology
  • Immunology
  • Pediatric Medicine

Background:

  • Rituximab (RTX) is widely used for multiple sclerosis (MS).
  • Limited data exists on RTX efficacy and safety in pediatric-onset MS.
  • Understanding RTX's risk-benefit profile in young MS patients is crucial.

Purpose of the Study:

  • To evaluate the efficacy and safety of Rituximab (RTX) in pediatric-onset multiple sclerosis.
  • To assess RTX's impact on clinical relapse rates and MRI activity.
  • To determine the proportion of patients achieving no evidence of disease activity (NEDA-3).

Main Methods:

  • Retrospective cohort study of 61 pediatric MS patients from Sweden, Austria, and Germany treated with RTX.
  • Assessed annualized relapse rates, Expanded Disability Status Scale (EDSS), and MRI parameters (T2 lesions, contrast-enhancing lesions) pre- and post-treatment.
  • Monitored adverse events, including infusion reactions and infections.

Main Results:

  • RTX treatment led to a significant reduction in annualized relapse rates (0.6 to 0.03).
  • MRI activity substantially decreased, with annual new T2 lesions dropping from 1.25 to 0.08 and contrast-enhancing lesions from 0.86 to 0.
  • 70% of patients achieved NEDA-3; 67% experienced adverse events, with 6 discontinuing treatment.

Conclusions:

  • Rituximab (RTX) demonstrates significant efficacy in reducing clinical and radiological disease activity in pediatric-onset multiple sclerosis.
  • RTX is a viable treatment option for pediatric MS, offering substantial disease control.
  • Careful monitoring for adverse events is recommended during RTX therapy in this population.
Abstract

Keywords:
central nervous systemcohort studydisease‐modifying therapypediatric‐onset multiple sclerosisrituximab

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