High-efficacy treatment for aggressive pediatric Multiple Sclerosis

Objectives: Pediatric-onset multiple sclerosis (POMS) is rarer than adult-onset disease, and it has different diagnostic and therapeutic challenges. It is known that POMS is characterized by a greater inflammatory activity than in adult patients, which is reflected in a more frequent polysymptomatic or ADEM-like onset, a high frequency of exacerbations, and a greater MRI burden at the onset of the disease. Also, in children, NEDA is achieved with less success when using standart first line lower-efficacy DMTs. Aim: to characterize the effectiveness and safety of natalizumab, ocrelizumab and rituximab in all POMS cases treated in Saint-Petersburg (Russia) Methods: Data from e-clinical records were retrospectively analyzed for all POMS cases treated with natalizumab, ocrelizumab and rituximab in Saint-Petersburg . Results: 11 children with aggressive MS began therapy with monoclonal antibodies (9 patients - natalizumab, 2 - ocrelizumab, 1 pftient was switched to rituximab and 1 to ocrelizumab). The mean age of onset of MS was 13,0±2,1yo. Start of HET was at 16,0 13±1,7 yo. In all patients, high-efficacy therapy showed a dramatic effect on suppressing inflammatory response (there were no exacerbations, no new or Gd+ lesions) throughout the observation period (32±15,8mo). Infections, oncological diseases were not revealed. Conclusion: Natalizumab, ocrelizumab and rituximab can be an effective and safe disease-modifying therapy for POMS. It is important to start HET for POMS as early as possible (including as the first line) to prevent disability.
Keywords: Pediatric-onset multiple sclerosis, natalizumab, ocrelizumab