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Optimizing treatment for pediatric multiple sclerosis
Nail Benallegue1,2, Fabien Rollot3,4,5,6, David-Axel Laplaud2,7
1Department of Pediatric Neurology, CHU Angers, Univ Angers, Angers, France.
Insights
High-efficacy therapies are recommended for pediatric-onset multiple sclerosis (POMS) due to heightened inflammation. Early treatment with these advanced therapies can improve outcomes and quality of life for children with POMS.
Area of Science:
- Neurology
- Immunology
- Pediatrics
Background:
- Pediatric-onset multiple sclerosis (POMS) presents unique clinical features compared to adult MS.
- POMS is characterized by increased inflammation, higher relapse rates, and greater lesion burden.
- Cognitive impairment and impaired brain growth are more pronounced in POMS, despite less early physical disability.
Purpose of the Study:
- To review current treatment strategies for POMS.
- To evaluate the safety and efficacy of various therapies in POMS.
- To provide expert opinion on optimizing POMS management.
Main Methods:
- Literature search of MEDLINE and Google Scholar (2000-2024).
- Review of observational studies and randomized controlled trials.
- Analysis of safety and efficacy data for POMS treatments.
Main Results:
- High-efficacy therapies (HETs) like fingolimod, natalizumab, and anti-CD20 agents show superior disease control and disability prevention.
- Early initiation of HETs is advised for better outcomes and quality of life in POMS.
- Lower/moderate-efficacy therapies are best suited for mild POMS cases.
Conclusions:
- HETs represent a promising standard of care for POMS, addressing its heightened neuroinflammatory activity.
- Further research is needed on long-term safety, prognostic markers, and de-escalation strategies.
- Future studies should focus on balancing disease control with adverse effects, considering aging and individual patient trajectories.
Introduction:
Pediatric-onset multiple sclerosis (POMS) differs from adult MS in its clinical characteristics and disease course. POMS exhibits a heightened inflammatory activity with higher relapse rates and lesion load, alongside less early physical disability but more pronounced cognitive impairment and impaired brain growth.
Areas Covered:
This review examines treatment strategy in POMS based on safety and efficacy data from observational studies and randomized controlled trials. This article is based on a literature search conducted using MEDLINE and Google Scholar for the period of 2000 to 2024.
Expert Opinion:
High-efficacy therapies, including fingolimod, natalizumab, and anti-CD20 therapies, have demonstrated superior disease control and disability prevention. Early initiation of HET is increasingly recommended to optimize outcomes and preserve quality of life.Low/moderate-efficacy therapies, such as interferons, glatiramer acetate, teriflunomide, dimethyl fumarate should be reserved for patients with mild disease. While long-term safety data, personalized prognostic markers and de-escalation strategies are still needed, high-efficacy therapies provide a promising standard of care, especially given enhanced neuroinflammatory activity in POMS. Future research should prioritize strategies to balance disease control with adverse effects (AEs), accounting for aging and individual disease trajectories, to improve long-term quality of life in POMS patients.
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