MS Relapse Rates After DMT Initiation Similar Between Pediatric-, Adult-Onset MS
Disability progression is slower among patients with pediatric-onset multiple sclerosis.
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The rate of relapse appears similar between patients with pediatric-onset multiple sclerosis (POMS) and adult-onset multiple sclerosis (AOMS) following the initiation of disease-modifying therapy (DMT), yet disability progression is slower among patients with POMS, according to a study presented at the 34th Congress of the European Committee for Treatment and Research in Multiple Sclerosis, held October 10-12, 2018, in Berlin, Germany.
The Swiss national MS registry was used to collect clinical data on patients with MS treated with first-line DMT between January 1995 and September 2017 (n=14726). Researchers defined disability progression as either a 1.0-step increase in the Expanded Disability Status Scale (EDSS) score vs the year prior and clinical confirmed 1 year later or as a 1.5-step increase if patients' EDSS at baseline was 0. Groups were matched based on sex, duration of disease, EDSS, type of DMT, year of initiation of DMT, and risk ratio in the 2 years before initiation of DMT.
Approximately 2.5% (n=364) of the cohort had a disease onset at age ≤18 years after starting first-lime DMT. At time of DMT initiation, the median disease duration was 1.4 years (interquartile range [IQR], 0.4-9.4), the number of relapses within a 2-year period prior to DMT initiation was 1 (IQR 1-2) and EDSS at baseline was 2.0 (IQR 1.5-3.0). At a median 6.3-year follow-up, data on a total of 201 patients with POMS and AOMS and 201 matched controls were available for analysis.
There was no difference between the 2 groups in terms of time to relapse following DMT initiation (log rank P =.48). Rates of relapse at 3 years and 5 years following DMT were 59% (95% CI, 52%-66%) and 68% (95% CI, 61%-74%), respectively, in POMS. Comparatively, relapse rates in the AOMS group were 54% [95% CI, 47%-61%] and 65% [95% CI, 58%-72%] at 3 years and 5 years, respectively. These differences resulted in a confounder-adjusted hazard ratio (HR) of 1.05 (95% CI, 0.83-1.31; P =.44).
Disability progression in the POMS group was 11% (95% CI, 8%-17%] and 19% [95% CI, 14%-26%] vs 18% (95% CI, 13%-24%) and 34% (95% CI, 27%-42%) of in AOMS group at 3 years and 5 years, respectively. Compared with AOMS patients, POMS was associated with a slower progression in disability (confounder-adjusted HR 0.6; 95% CI, 0.41-0.86; P =.013).
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Décard B. Time to relapse is comparable in pediatric- and adult-onset multiple sclerosis patients after the initiation of disease-modifying therapy. Presented at: 34th Congress of the European Committee for Treatment and Research in Multiple Sclerosis. October 10-12, 2018; Berlin, Germany. Abstract P992.