Effect of Modern Therapy on Disease Progression in Pediatric MS

Background/Purpose: Current therapy concepts in multiple sclerosis (MS) are based on the early separation of patients with mild/moderate or highly active disease activity. Aim of the study was to determine the effect of this treatment approach on disease progression in pediatric MS.

Methods: Retrospective single-center study in the German Center for MS in children and adolescents was conducted.

Results: 41% of all patients fulfilled the criteria for highly active MS. Predictive of having highly active MS was a high T2 lesion load and a high number of contrast-enhancing lesions on the MRI at MS diagnosis. 69 of the highly active MS patients were treated with natalizumab and 27 with fingolimod. Treatment with natalizumab led to a 95% reduction in annual relapse rate (ARR), a 97% reduction of new T2 lesions and 100% reduction of contrast-enhancing lesions. In patients who were previously treated with an interferon or glatiramer acetate, commencement of fingolimod led to a 75% reduction of ARR, an 80% reduction of new T2 lesions, and a 93% reduction of contrast-enhancing lesions. Patients who were previously treated with natalizumab on the other hand experienced a significant increase in disease activity when switched to fingolimod. Comparison of the pediatric MS cohort in Göttingen from 2005 with 2015 showed a 46% reduction of ARR and a 44% reduction of mean EDSS.

Conclusion: Early separation and treatment of pediatric MS patients according to disease activity leads to a significant reduction in ARR and EDSS. Current protocols for the treatment of pediatric MS therefore offer a significant benefit for the patients.