Persistent Disability in Pediatric Onset MS Has Substantially Declined Over Time

Improvements made in recent years in the treatment and management of multiple sclerosis (MS) in children have led to a significant reduction in persistent disability in patients with MS, according to research results published in JAMA Neurology.

This was a retrospective, multicentre, observational study in which research researchers analyzed data reported in the Italian MS registry. They focused on 3,198 pediatric patients with MS (mean age at baseline, 15.2 years) who were less than 18 years old at the time of MS diagnosis and had a disease duration of at least 3 years.

Researchers compared different diagnostic periods of MS (<1993, 1993-1999, 2000-2006, and 2007-2013) with respect to the time it took to reach disability milestones. The disability milestones include Expanded Disability Status Scale (EDSS) scores of 4.0 and 6.0.

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In the total study cohort, the median time to diagnosis was 3.2 years. In addition, the median annual relapse rate in the first year from baseline was 1.3 compared to 0.6 in the first 3 years. Over the mean follow-up period of 21.8 years, the median survival times to reach the 4.0 and 6.0 disability milestones were 31.7 and 40.5 years, respectively.

Study researchers reported a gradual decrease in the cumulative risk of EDSS score 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) at later periods of diagnosis. These DMTs were also administered earlier and for longer periods of time compared to previous eras.

Limitations of this study included the lack of magnetic resonance imaging data, retrospective design, and lack of cognitive assessment data.

Researchers concluded that their findings are likely due to “improvements in therapeutic and management standards” and suggested that “an increase in approved DMTs before the age of 18 and upgrades in drug safety may lead to further improvement in prognosis in these population “in the coming years.

Disclosure: Several authors of the study stated links to the pharmaceutical industry. For a complete list of authors’ disclosures, see the original reference.

Reference

Baroncini D, Simone M, Iaffaldano P, et al. Risk of persistent disability in multiple sclerosis patients, childhood onset. Published online May 3, 2021. JAMA Neurol. doi: 10.1001 / jamaneurol.2021.1008

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