Multiple sclerosis in children: treat earlier to treat better

Multiple sclerosis in children: treat earlier to treat better


Treat first to treat better and avoid the risk of disability. This is the main result that emerges from a large international analysis involving over 5000 children with pediatric onset of multiple sclerosis. The study saw the participation of several Italian researchers and has just been published on Lancet Child & Adolescent Health. And it is from here that, strengthened by the evidence, the researchers send a clear message to the community of clinicians who follow pediatric patients: “Children with relapsing-remitting multiple sclerosis should be treated early with highly effective therapies, before developing important problems neurological, so as to better preserve their neurological abilities.”

Multiple sclerosis in children and adolescents

The recommendations come after analyzing the progression of the disease drawing on data from an international registry representing 41 countries and from the Italian multiple sclerosis registry. The idea behind the study, explain the authors themselves, was to understand how highly effective drugs, which in adults have already shown the ability to reduce the accumulation of disabilities, worked in the pediatric population, i.e. when sclerosis multiple occurs before the age of 18. In particular, the intention was to understand the outcomes of therapies started in the early stages of the disease, in conditions of so-called “minimal disability”, when the damage is still limited.

According to reports AISM, the Italian multiple sclerosis association, pediatric diagnoses concern less than 10% of cases, more often after the age of ten. In children, multiple sclerosis presents symptoms that mostly overlap with those in adults (visual, motor and walking disorders), but drowsiness, epileptic seizures and cognitive disorders may also be present. Generally, the experts add, recovery after episodes of relapses in children is faster, but still associated with a risk of worsening over time in terms of disability.

The analysis

The researchers analyzed the type of therapy received and any changes in the level of accumulated disability or transition towards secondarily progressive forms (the progressive forms of multiple sclerosis are the most serious of the disease) to understand which therapies were most effective, and how much, in reducing the risk of worsening in the pediatric population (where, unlike the adult population, the evidence from clinical trials is more limited).

In detail, the researchers tried to distinguish the effects of so-called “highly effective” “disease-modifying” therapies from those with lower efficacy. By “disease-modifying therapies” we mean those treatments that aim to influence the progress of the disease, delaying its progression and reducing relapses. The first large group – that of highly effective therapies – includes drugs such as alemtuzumab, cladribrine, fingolimod, natalizumab, ocrelizumab and rituximab – while the other includes drugs such as interferon beta, glatiramer acetate, and dimethyl fumarate, for example .

Treat first to reduce disability

Putting the results together, the researchers observed that the effectiveness of the therapies was greater when they were administered early, at low or moderate levels of disability, both in the case of low- and high-efficacy treatments. However, the greatest benefits were for highly effective therapies. “It is the largest study of its kind on the pediatric population and we hope that it will be able to have repercussions, so that children with multiple sclerosis can access the most effective therapies as soon as possible,” he commented Sifat Sharmin from the University of Melbourne, first author of the study. The recommendation, however – the experts point out at the end of their study – must take into account the safety profile and acceptability of the various therapies (which have different methods of administration, some oral, others by injection), always considering any risks of immunosuppression in the long term.


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