Effects of disease modifying therapy on cognitive proficiency in pediatric-onset multiple sclerosis (POMS)

Disease-modifying therapies (DMTs) may mitigate well-documented cognitive challenges in pediatric-onset multiple sclerosis (POMS) by slowing disease progression and promoting production of neurotrophic factors, though studies are limited, especially in children. This study assessed cognitive proficiency in patients with POMS treated with DMTs.

The sample (n = 26; x̄ age at diagnosis = 14.6 years) was treated with dimethyl fumarate, natalizumab, or B-cell depletion therapies. Neuropsychological outcomes included attention/working memory (WM) and processing speed (PS) as measured by Digit Span (DS) and Rapid Automatized Naming (RAN) subtests.

Both WM and PS were clinically average for the sample (WM x̄ = 8.7; PS x̄ = 8.5). There were differences between DMT groups in PS, RAN F(2,23) = 7.9, p = 0.002, though not WM. Patients treated with natalizumab (DS x̄ = 6.8; RAN x̄ = 5.8) demonstrated low average to below average performance, clinically lower than average performance across those treated with dimethyl fumarate (DS x̄ = 8.6; RAN x̄ = 9.0) or B-cell depletion (DS x̄ = 9.3; RAN x̄ = 9.4).

In this cross-sectional cohort, all patients treated with B-cell depletion therapies performed within the average to high average range. While those treated with dimethyl fumarate displayed more variability, their mean/median scores fell within the average range. In contrast, patients treated with natalizumab demonstrated low average to below average scores, suggesting immune-modulating therapeutics such as dimethyl fumarate and B-cell depletion may potentially be more beneficial than therapies that only prevent immune cell ingress into the central nervous system.