Early treatment with DMT effective in paediatric-onset MS

In an observational study, disease progression independent of relapse activity (PIRA) was less frequent in paediatric-onset MS (POMS) than in adult-onset MS (AOMS). However, even in POMS, PIRA accounted for about half of all confirmed disability accumulations. Early treatment with disease-modifying therapy (DMT) was effective in preventing PIRA, especially in POMS patients.

A real-world, multicentre, cohort study set out to compare the proportion of PIRA in POMS and AOMS patients [1]. Extracted from the Italian MS Registry were 5,169 patients with clinically isolated syndrome and relapsing-remitting MS, assessed <1 year from onset and with follow-up of up to 5 years. They were stratified by age at onset in POMS (<18 years, n=323) and AOMS (>18 years, n=4,846).

PIRA (assessed using multivariable Cox regression models) was less frequent in POMS, occurring in 22.6% of participants compared with 33.8% in AOMS. PIRA accounted for 47.8% of confirmed disability accumulation events in POMS and 66.7% in AOMS during the entire follow-up of 12.2 years (P<0.001). In both cohorts, PIRA was associated with longer disease duration. A multi-variable analysis confirmed POMS to be a protective factor against PIRA (HR 0.665; P=0.001). Some of the most important factors associated with the risk of PIRA were longer baseline disease duration (HR 1.574; 95% CI 1.307–1.897; P<0.001), lower baseline EDSS score (HR 0.868; 95% CI 0.832–0.905; P<0.001), lower number of relapses before the event (HR 0.62; 95% CI 0.585–0.657; P<0.001), and longer follow-up spent on a DMT (HR 0.468; 95% CI 0.413–0.531; P<0.001). In both cohorts, longer exposure to DMTs reduced the risk of PIRA as well as relapse-associated worsening (P<0.001). This effect was especially evident in POMS.

The fact that even in POMS, PIRA accounted for about half of all confirmed disability accumulations, suggests that MS could be considered as a continuum. Relapse-dependent disability worsening would then be interwoven with relapse-independent worsening from the very onset of MS. Dr Emilio Portaccio (University of Florence, Italy) stressed that the demonstrated effectiveness of early treatment with DMTs, especially in POMS, was the most important result of the study [1]. This strategy may slow down the transition to the progressive phase of MS and reduce the long-term burden.

1. Bellinvia A, et al. Progression independent of relapse activity can occur in paediatric-onset multiple sclerosis and can be prevented by disease modifying drugs. Abstract O071, ECTRIMS 2022, 26–28 October, Amsterdam, the Netherlands.

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Posted on 20 December 2022