https://doi.org/10.55788/06676677
Most DMTs lack efficacy data in children, which makes paediatric-onset MS (POMS) treatment challenging. The use of newer DMTs in POMS lags behind from that in adults, though a large, retrospective analysis supports the use of newer DMTs over injectables in POMS [1]. Data on switching DMTs in POMS is, however, scarce. A cohort study of children with MS or CIS at 12 US clinics was set up to compare the real-world effectiveness of switching from platform injectable (interferon-β or glatiramer acetate) to oral (dimethyl fumarate, fingolimod, or teriflunomide) or infusion therapy (natalizumab, rituximab, ocrelizumab, or alemtuzumab) versus switching to other injectable DMT [2].
Overall, 212 children whose first treatment was a platform injectable and who switched DMT before they were 18 years, were included in the analysis. They were stratified into 3 groups: 1) switchers to another injectable (n=93); 2) switchers to an oral DMT (n=76); and 3) switchers to infusion DMT (n=43). Groups 2 and 3 were older at onset (group 1 12.3 years; group 2 13.5 years; group 3 14.2 years) and switch date (group 1 14.6 years; group 2 16 years; group 3 15.7 years). Participants that switched to infusion were more likely to have new enhancing lesions prior to switching (group 1 45%; group 2 28%; group 3 67%). Follow-up was up to 4 years.
The primary outcome was the annualised relapse rate (ARR), which was 0.59 in group 1, 0.22 in group 2, and 0.15 in group 3. Results were similar for the adjusted analysis (see Table).
Table: Adjusted primary analysis outcomes [2]
NNT, number needed to treat.
Secondary outcomes included markers of radiological disease activity. Results were displayed as the time it took for 50% of each group to develop new T2 lesions. In groups 1, 2, and 3 this was 0.49, 1.25, and 1.99 years, respectively.
In conclusion, switching from a platform injectable to an oral or infusion DMT as opposed to another injectable DMT led to better disease activity control of paediatric MS. Long-term safety data for oral and infusion DMTs are required.
- Krysko KM, et al. Ann Neurol. 2020;88(1):42–55.
- Abrams A. Real-world effectiveness of switching treatment after initial platform injectable disease-modifying therapies in pediatric multiple sclerosis in the US. Abstract O070, ECTRIMS 2022, 26–28 October, Amsterdam, the Netherlands.
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Table of Contents: ECTRIMS 2022
Featured articles
Letter from the Editor
Diagnosis and Prediction of Disease Course
A case for including optic nerve lesions in the McDonald criteria
Cerebrospinal fluid kappa-free light chains for MS diagnosis
Early, non-disabling relapses increase disability accumulation
Physical impairment is present before perceived MS onset
Chronic active MS lesions respond poorly to anti-CD20 antibodies
Treatment: Trials & Strategies
Dimethyl fumarate reduces the risk of a first clinical event in RIS
How and when to make a timely switch to high-efficacy DMT
Comparing real-world effectiveness of DMTs
Study fails to show non-inferiority of rituximab to ocrelizumab
Autologous haematopoietic stem cell transplantation versus DMTs
Progressive MS
Stem cell transplantation not superior to natalizumab in progressive MS
Efficacy of DMTs fades away in secondary progressive MS
Smartphone tapping can help detect progressive MS
Paediatric MS
Early treatment with DMT effective in paediatric-onset MS
Fingolimod in paediatric MS: results of up to 6 years
Switching treatment after initial platform injectable DMT: real-world data
Pregnancy
Pregnancy and infant outcomes in women receiving ocrelizumab
New safety data of anti-CD20 mAbs around pregnancy
MS activity and pregnancy outcomes after long-term use of natalizumab
NMOSD
Ravulizumab significantly reduced relapses in AQP4+ NMOSD
NMOSD patients are cognitively impaired regardless of serostatus
Evidence-based consensus on pregnancy in NMOSD
COVID-19
COVID-19 and MS: lessons learned thus far
Ocrelizumab and fingolimod increase the risk of COVID-19 and of worse outcomes
Humoral and cellular immune responses after SARS-CoV-2 vaccination
Miscellaneous
Re-myelination strategies in MS still pose many unanswered questions
MS associated with a broader Epstein-Barr virus specific T-cell receptor repertoire
Cognitive rehab and mindfulness reduce cognitive complaints in MS
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