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Treatment persistence in paediatric-onset multiple sclerosis: A Swedish nationwide registry study

Fredrik Sandesjö1, Kyla A McKay2, Katharina Fink3

  • 1Neuropediatric Unit, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.

Multiple Sclerosis (Houndmills, Basingstoke, England)
|May 31, 2026
PubMed

Insights

Rituximab showed the highest treatment persistence in paediatric-onset multiple sclerosis (PoMS), suggesting B-cell depletion is a strong first-line therapy. This study compared various disease-modifying therapies (DMTs) for effectiveness and tolerability in young MS patients.

Area of Science:

  • Neurology
  • Immunology
  • Pharmacology

Background:

  • Comparative studies on highly effective therapies for paediatric-onset multiple sclerosis (PoMS) are limited.
  • Understanding treatment persistence is crucial for assessing effectiveness and tolerability in PoMS.

Purpose of the Study:

  • To compare treatment persistence across various disease-modifying therapies (DMTs) in individuals with PoMS.
  • To evaluate the effectiveness and tolerability of different DMTs as a proxy for treatment persistence.

Main Methods:

  • A nationwide cohort study utilizing the Swedish MS Registry.
  • Inclusion of individuals with MS onset before age 18, from 2000 to 2024.
  • Analysis of treatment persistence using Kaplan-Meier and Cox models, adjusted for covariates.

Main Results:

  • Rituximab demonstrated the highest treatment persistence, never dropping below 50%.
  • Compared to injectables, rituximab, natalizumab, fingolimod, and dimethyl fumarate showed significantly lower discontinuation rates.
  • Median persistence varied, with rituximab showing the longest duration, while injectables had the shortest.

Conclusions:

  • Rituximab exhibits superior treatment persistence in PoMS patients.
  • B-cell depletion therapy, exemplified by rituximab, is supported as a potential first-line treatment option for PoMS.
Abstract

Keywords:
Disease-modifying therapieschildrencohort studyreal-world evidence

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