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Delayed initiation of disease modifying therapy increases relapse frequency and motor disability in pediatric onset
Saba Jafarpour1, Soniya Pinto2, My H Vu3
1Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, USA; Department of Neurology, Keck School of Medicine of the University of Southern California, USA.
Insights
Starting disease-modifying treatment (DMT) sooner for pediatric-onset Multiple Sclerosis (POMS) is crucial. Delayed DMT initiation is associated with worse outcomes, including higher relapse rates and longer 25-foot walk times.
Area of Science:
- Neuroimmunology
- Pediatric Neurology
- Multiple Sclerosis Research
Background:
- Pediatric-onset Multiple Sclerosis (POMS) requires timely intervention to mitigate long-term disability.
- Understanding the impact of treatment timing on disease progression in POMS is essential for optimizing patient care.
Purpose of the Study:
- To investigate the association between the time to initiation of disease-modifying treatment (DMT) and clinical and MRI outcomes in children and adolescents with POMS.
Main Methods:
- Retrospective analysis of 68 patients with POMS from two pediatric neuroimmunology clinics.
- Outcome measures included annualized relapse rate (ARR), MRI lesion burden, EDSS, and 25-foot walk duration.
- Univariate and multivariate regression analyses were employed to assess the relationship between delayed DMT and outcomes.
Main Results:
- Delayed DMT initiation correlated significantly with a higher ARR (p=0.0016) and longer 25-foot walk duration (p=0.0077).
- Multivariate analysis confirmed delayed DMT as a predictor of higher ARR (p=0.002) and longer 25-foot walk duration (p=0.047).
- Delayed DMT and use of low/moderate efficacy DMT predicted the presence of Gadolinium-enhancing lesions (p=0.004 and p=0.019, respectively).
Conclusions:
- Early initiation of disease-modifying treatment in POMS is associated with more favorable outcomes.
- Delayed treatment correlates with increased relapse activity and greater motor impairment.
- These findings underscore the importance of prompt DMT initiation in managing pediatric MS.
Objective:
To evaluate association between time to initiation of disease modifying treatment (DMT) and outcomes in pediatric-onset Multiple Sclerosis (POMS).
Methods:
A retrospective analysis of children with POMS from two tertiary referral pediatric Neuroimmunology clinics. Outcome measures comprised annualized relapse rate (ARR), MRI lesion burden (T1, T2-FLAIR, and post-GAD contrast sequences), EDSS, and 25-ft walk duration at the latest follow-up visit. Univariate and multivariate analysis using linear and logistic regression models were used to assess associations between patient characteristics and outcomes.
Results:
In total, 68 patients were reviewed. More than half of patients were female (62 %) and 32 (47 %) were Hispanic/LatinX. Median age at diagnosis was 14.2 years (IQR: 11.0-16.5), and median duration from diagnosis to the latest follow-up was 2.5 years (IQR: 1.6-4.6). Sensory (29.4 %), brainstem (23.5 %), and pyramidal (19.1 %) symptoms were most common. Interferon beta (32.4 %), dimethyl fumarate (27.9 %) and rituximab (26.5 %) were the most frequently used first-line DMT. Patients had a median ARR of 0.5 (IQR: 0.08-0.84), and EDSS score of 1.0 (IQR: 0.0-2.0) at the most recent follow-up. Delayed DMT initiation correlated with higher ARR (R = 0.38, p = 0.0016) and longer 25-ft walk duration (R = 0.34, p = 0.0077). In multivariate analysis, delayed DMT remained a significant predictor of higher ARR (p = 0.002) and longer 25-ft walk duration (p = 0.047). Delayed DMT initiation and use of low/moderate efficacy DMT predicted GAD enhancing lesions at the latest follow-up (p = 0.004 and 0.019 respectively).
Conclusion:
Delayed DMT initiation in POMS is linked to unfavorable outcomes, including higher ARR and longer 25-ft walk duration.
