The following article is part of conference coverage from the Americas Committee for Treatment and Research in Multiple Sclerosis 2020 Forum in West Palm Beach, Florida. Neurology Advisor‘s staff will be reporting breaking news associated with research conducted by leading experts in neurology. Check back for the latest news from the ACTRIMS 2020 Forum.


WEST PALM BEACH, FL — Using newer disease-modifying therapies for the initial treatment of pediatric multiple sclerosis may be more effective than injectables at controlling disease activity, according to study results presented at the 2020 Forum for Americas Committee for Treatment and Research in Multiple Sclerosis held February 27-29, 2020, in West Palm Beach, Florida.

Most disease-modifying therapies used in the treatment of multiple sclerosis are not well studied in children; therefore, the treatment of multiple sclerosis in the pediatric population remains a challenge. The objective of this study was to assess the efficacy of initial treatment with new disease-modifying therapies vs injectable therapies on disease activity in pediatric multiple sclerosis and clinically isolated syndrome.

Researchers examined demographic data and clinical outcomes of children with multiple sclerosis and clinically isolated syndrome who received initial therapy with new disease-modifying therapies (such as fingolimod, dimethyl fumarate, and rituximab) or injectable disease-modifying therapies (interferon beta or glatiramer acetate). They used logistic regression to compute propensity score that could be used to predict use of new therapies, including preidentified confounders such as gender, race, age at onset, and relapse count within 6 months. Relapse rate after prescription of initial therapy and time to new or enlarging brain lesions were adjusted for propensity scores-quintile. 


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Researchers found that 741 children started therapy before 18 years of age, 197 of whom received newer therapies and 544 of whom received injectable therapies. Patients who wer prescribed newer therapies tended to be older (15.2 years vs injectable at 14.4 years; P =.001) and less likely to have a monofocal presentation (37% vs injectable 55%; P <.001). Patients who were prescribed newer therapies had a lower number of relapses in the past 6 months compared with those who were prescribed injectables (0.8 vs 1.0), as well as lower rates of new or enlarging T2 brain lesions (hazard ratio, [HR] 0.51; 95% CI, 0.36-0.72; P <.001) and gadolinium-enhancing brain lesions (HR, 0.38; 95% CI, 0.23-0.63; P <.001).

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The researchers concluded that in pediatric multiple sclerosis and clinically isolated syndrome, treatment with newer disease-modifying therapies could be more effective in controlling disease activity than injectable therapies.

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Reference

Krysko KM, Graves JS, Rensel M, et al. Real-world effectiveness of initial treatment with newer versus injectable disease-modifying therapies in pediatric multiple sclerosis. Presented at: Annual Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS) Forum; February 27-29, 2020; West Palm Beach, FL. Abstract P066.