Early predictors of disability progression in paediatric-onset MS

Progression of disability in patients with paediatric-onset MS can be predicted by relapse frequency, greater number of relapses with incomplete recovery, higher disability during the first year of the disease, older age at symptom onset, and the presence of pyramidal, visual, or cerebellar symptoms. In contrast, persistent treatment with high-efficacy disease-modifying therapies (DMTs), brainstem relapse, and complete recovery from the first relapse demonstrated a protective effect against disease progression [1].

Paediatric-onset MS patients (3–10% of the total MS population) demonstrate higher relapse rates than adult-onset MS patients in the first year of the disease [2,3]. Moreover, these patients reach irreversible disability milestones at an earlier age than adult-onset patients: over 50% of the patients with paediatric-onset MS are classified as secondary progressive MS patient by the age of 30 years [2,4]. Treatment with high-efficacy DMTs potentially slows down disease progression in this population [5]. The current study aimed to identify early predictors of disease worsening in paediatric-onset MS, to aid decision makers in the initiation of high-efficacy DMTs. In total, 672 patients <18 years at symptom onset were followed via biennial visitations. Multiple Sclerosis Severity Score (MSSS) and Expanded Disability Status Scale (EDSS) worsening were the outcome measures of interest. Dr Sifat Sharmin (University of Melbourne, Australia) presented the late-breaking results.

Older age at MS onset (OR 1.09; 95% CI 1.03–1.16), high EDSS score during the first 12 months of the disease (OR 1.32; 95% CI 1.21–1.45), relapse frequency (OR 1.04; 95% CI 0.96–1.13), and the presence of pyramidal (OR 1.34; 95% CI 1.13–1.58), visual (OR 1.28; 95% CI 1.10–1.48), or cerebellar symptoms (OR 1.17; 95% CI 1.00–1.37) were significantly associated with MSSS worsening. Longer duration of high-efficacy DMT treatment (OR 0.96; 95% CI 0.93–0.99), complete recovery from first relapse (OR 0.78; 95% CI 0.63–0.96), and brainstem relapse (OR 0.79; 95% CI 0.67–0.92) demonstrated a protective effect. Dr Sharmin added that 76% of patients with paediatric-onset MS worldwide are treated with DMTs, of whom only 27% are treated with high-efficacy DMTs. The results of the current study could aid clinicians in identifying patients at risk of disability worsening at an early stage of the disease, enabling them to initiate high-efficacy DMTs swiftly.

1. Sharmin S, et al. Early predictors of disability in paediatric multiple sclerosis: evidence from a multi-national cohort. LB187, ECTRIMS 2021 Virtual Congress, 13–15 October.
2. Banwell B, et al. Lancet Neurol. 2007;6(10):887–902.
3. Gorman MP, et al. Arch Neurol. 2009;66(1)54–59.
4. Waldman A, et al. Lancet Neurol. 2014;13(9):936–948.
5. Amato MP, et al. Brain. 2020;143(10)3013–3024.

 

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Posted on 9 December, 20219 December, 2021