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Therapeutic Advances in Pediatric Multiple Sclerosis
Rachel Walsh1,2, Tanuja Chitnis1,2
1Division of Child Neurology, Mass General Brigham Pediatric MS Center, Boston, MA 02114, USA.
Insights
Pediatric-onset multiple sclerosis (POMS) treatments are evolving, with new therapies showing promise for children and adolescents. This review covers key clinical trials and treatment strategies for managing this chronic neurological condition.
Area of Science:
- Neurology
- Immunology
- Pediatrics
Background:
- Pediatric-onset multiple sclerosis (POMS) is a chronic, immune-mediated central nervous system disorder affecting 3-10% of MS patients before age 18.
- Most pediatric MS cases present with a relapsing-remitting course and significant disease activity.
- Historically, pediatric MS treatments were off-label, with limited success.
Purpose of the Study:
- To review therapeutic advancements in pediatric multiple sclerosis.
- To discuss the safety and efficacy of emerging treatments and monoclonal antibodies.
- To examine treatment strategies and considerations for POMS patients.
Main Methods:
- Narrative review of seminal clinical trials in pediatric MS.
- Evaluation of therapies including fingolimod, dimethyl fumarate, teriflunomide, ocrelizumab, and alemtuzumab.
- Review of safety and efficacy data for monoclonal antibodies.
Main Results:
- Seminal trials like PARADIGMS, CONNECT, TERIKIDS, OPERETTA I, and LEMKIDS have provided data on specific treatments for POMS.
- Emerging therapies and monoclonal antibodies offer new options for pediatric MS management.
- Evidence supports the evaluation of different treatment strategies, including induction versus escalation.
Conclusions:
- Therapeutic options for POMS have rapidly expanded with new drug approvals and clinical trial data.
- Understanding the safety, efficacy, and strategic application of these treatments is crucial for optimizing patient care.
- Further research and clinical experience are needed to refine treatment protocols for pediatric multiple sclerosis.
Abstract:
Pediatric-onset multiple sclerosis (POMS) is a chronic, immune-mediated disorder that affects the central nervous system in children and adolescents. Approximately 3-10% of MS patients have an onset that occurs before the age of 18. The vast majority of pediatric MS cases are characterized by a relapsing-remitting course with a high burden of disease activity. Pediatric MS patients were historically treated off-label with varying degrees of success. With the approval of many new therapies for adult-onset MS, alternative treatments in pediatric MS have rapidly started to emerge. In this narrative review, we will discuss therapeutic advancements in pediatric multiple sclerosis, including the seminal trials of PARADIGMS, which evaluated fingolimod use in pediatric MS patients, CONNECT (dimethyl fumarate), TERIKIDS (teriflunomide), OPERETTA I (ocrelizumab), and LEMKIDS (alemtuzumab). We will also review the safety and efficacy of different monoclonal antibodies that are commonly prescribed for multiple sclerosis. We will then examine induction versus escalation treatment strategies and conclude with discussions on treatment considerations in POMS patients.
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