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Published on: December 9, 2015
First-Line Rituximab in Pediatric-Onset Multiple Sclerosis: Clinical and MRI Outcomes in a Retrospective Cohort
Hannah Lewis1, Alexandra Kiss2, Praveen Ramani1
1Department of Pediatrics, Division of Pediatric Neurology, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
Insights
Rituximab shows promise as a first-line therapy for pediatric-onset multiple sclerosis (POMS). This study found it to be well-tolerated and highly effective in preventing relapses and MRI activity in children with POMS.
Area of Science:
- Pediatric Neurology
- Immunology
- Neuroimaging
Background:
- Pediatric-onset multiple sclerosis (POMS) requires effective long-term therapies.
- B-cell depletion therapies are increasingly utilized, but data on rituximab as a first-line treatment in POMS are limited.
Purpose of the Study:
- To evaluate the efficacy and safety of rituximab as a first-line chronic disease-modifying therapy in children with POMS.
Main Methods:
- Retrospective review of 17 children with POMS treated with rituximab as their initial long-term therapy.
- Clinical data collection from medical records.
- Standardized re-review of brain MRI scans by a neuroradiologist to assess T2 lesion counts.
Main Results:
- No clinical relapses occurred after rituximab became therapeutically active (≥6 months post-initiation).
- 94% of patients achieved a composite outcome of clinical and MRI activity-free status.
- T2 lesion counts remained stable or decreased in all patients compared to baseline.
Conclusions:
- Rituximab demonstrates preliminary support as a well-tolerated, high-efficacy first-line treatment for POMS.
- Larger prospective studies are warranted to confirm these findings.
Abstract:
B-cell depletion is increasingly used in pediatric-onset multiple sclerosis (POMS), but data on rituximab as first-line chronic therapy remain limited. We retrospectively reviewed 17 children with POMS who received rituximab as their initial long-term disease-modifying therapy at a single tertiary children's hospital. Clinical data were collected from the medical record and all contrast-enhanced brain magnetic resonance images (MRIs) were re-reviewed by a neuroradiologist for standardized T2 lesion counts. Median treatment duration was 126 weeks. After rituximab became therapeutically active (≥6 months after initiation), no clinical relapses occurred. Sixteen patients (94%) achieved a clinical + MRI activity-free composite outcome (no relapses and no new/enlarging T2 or gadolinium-enhancing lesions). Total T2 lesion counts were stable or decreased in all patients compared with the post-induction baseline. Adverse events were infrequent with no serious adverse events reported. These findings provide preliminary support for rituximab as a well-tolerated, first-line high-efficacy approach in POMS and warrant larger prospective studies.
