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Real-World Effectiveness of Switching to Oral or Infusion Versus Injectable Disease-Modifying Therapy in Pediatric

Aaron W Abrams1, Michael Waltz2, T Charles Casper2

  • 1Department of Neurology, Cleveland Clinic, Cleveland, OH.

Annals of Neurology
|November 6, 2025
PubMed

Insights

Switching pediatric multiple sclerosis (MS) patients from injectable disease-modifying therapies (DMTs) to oral or infusion treatments significantly reduced relapse rates. These findings highlight improved disease control with newer DMT classes in young MS patients.

Area of Science:

  • Pediatric Neurology
  • Neuroimmunology
  • Clinical Therapeutics

Background:

  • Platform injectable therapies are common initial treatments for pediatric multiple sclerosis (MS) and clinically isolated syndrome (CIS).
  • Assessing the effectiveness of switching disease-modifying therapies (DMTs) is crucial for optimizing treatment strategies in pediatric MS patients.
  • Real-world data on switching DMTs in this population are limited.

Purpose of the Study:

  • To evaluate the effectiveness of switching from initial platform injectable DMTs to other DMT classes (injectable, oral, or infusion) in pediatric MS and CIS patients.
  • To compare disease activity, specifically relapse rates, among different DMT switching strategies.
  • To provide evidence-based insights for clinical decision-making in managing pediatric MS.

Main Methods:

  • Retrospective analysis of 2615 pediatric-onset demyelinating disease patients from the US Network of Pediatric MS Centers.
  • Included patients with MS/CIS initially treated with platform injectables who switched to injectable, oral, or infusion DMTs.
  • Negative binomial regression was used to model relapse rates, adjusting for confounders.

Main Results:

  • Of 212 children who switched DMT, 76 switched to oral and 43 to infusion therapies.
  • Switching to oral or infusion DMTs was associated with significantly lower annualized relapse rates (ARR) compared to remaining on injectables (0.34 and 0.18 vs. 0.88, respectively).
  • The number needed to treat to prevent one relapse was substantially lower for oral (1.84) and infusion (1.43) switches compared to injectable-to-injectable switches.

Conclusions:

  • Switching from platform injectable DMTs to oral or infusion therapies demonstrates superior disease control in pediatric MS and CIS patients.
  • These findings support the use of oral or infusion DMTs for improved outcomes in pediatric MS.
  • Further research on the long-term safety and efficacy of these switches is warranted.
Abstract

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