Improvements made in recent years in the treatment and management of multiple sclerosis (MS) occurring in children have resulted in significant reductions in persistent disability in patients with MS, according to study results published in JAMA Neurology.
This was a retrospective, multicenter observational study in which the investigators analyzed the data reported in the Italian MS registry. They focused on 3,198 pediatric MS patients (mean starting age 15.2 years), who were younger than 18 years of age at the time of MS diagnosis and had had a disease duration of at least 3 years.
The study’s investigators compared different diagnostic epochs of MS (<1993, 1993-1999, 2000-2006, and 2007-2013) in terms of the time it took to reach disability milestones. Milestones for disability included EDSS (Expanded Disability Status Scale) scores of 4.0 and 6.0.
Continue reading
In the entire study cohort, the median time to diagnosis was 3.2 years. In addition, the median annualized relapse rate from the start was 1.3 for the first year versus 0.6 for the first 3 years. During the median follow-up of 21.8 years, the median survival times for reaching disability milestones of 4.0 and 6.0 were 31.7 and 40.5 years, respectively.
The investigators of the study reported a gradual decrease in the cumulative risk of reaching the EDSS value 4.0 (hazard ratio) [HR]0.70; 95% CI, 0.58-0.83 in 1993-1999; HR 0.48; 95% CI, 0.38-0.60 in 2000-2006; and HR 0.44; 95% CI, 0.32-0.59 in 2007-2013) and EDSS score 6.0 (HR, 0.72; 95% CI, 0.57-0.90 in 1993-1999; HR, 0, 44; 95% CI, 0.33-0.60 in 2000-2006; and HR, 0.30; 0.20-0.46 in 2007-2013).
A higher proportion of patients with pediatric MS were treated with disease-modifying therapies (DMTs) in later periods of diagnosis. These DMTs were also administered earlier and for longer periods of time than in previous epochs.
Limitations of this study included the lack of magnetic resonance imaging data, retrospective design, and the lack of cognitive assessment data.
The study’s researchers concluded that their results were likely due to “improvements in therapy and management standards” and suggested that “an increase in approved DMT before age 18 and an improvement in drug safety add to another Improving the prognosis in this population can lead to “coming years.
Disclosure: Several authors of the study have stated that they are part of the pharmaceutical industry. For a full list of the authors’ information, see the original reference.
reference
Baroncini D., Simone M., Iaffaldano P. et al. Risk of persistent disability in patients with pediatric multiple sclerosis. Published online May 3, 2021. JAMA Neurol. doi: 10.1001 / jamaneurol.2021.1008
