Disease Modifying Therapy Utilization in Pediatric Multiple Sclerosis: A Multi-center Retrospective Study
Amara Miller1, Heather Held2, Thomas DeCesare3, Frederick Bassal4, Vaishnavi Vaidyanathan5, Jonathan Santoro 6
1University of Arizona-College of Medicine Phoenix, 2University of Arizona College of Medicine Phoenix, 3Creighton Medical School, 4Barrow Neurological Institute At Phoenix Children's Hospital, 5Barrow Neurological Institute at Phoenix Children's Hospital, 6Division of Neuroimmunology, Children’s Hospital Los Angeles and the Keck School of Medicine of USC
Objective:
To evaluate trends in DMT use in individuals with POMS and determine if there were demographic factors that influence utilization.
Background:
Emerging data suggests that higher efficacy DMTs may improve long term health outcomes for individuals with pediatric onset multiple sclerosis (POMS), particularly when considering they have higher relapse rates than adults with multiple sclerosis.
Design/Methods:
A retrospective, multi-center study of individuals diagnosed with POMS prior to the age of 18 per 2013 IPMSSG criteria was performed. Information regarding clinical history, disease duration, EDSS scores, laboratory findings, and treatment history was collected through retrospective chart review. DMTs were categorized by efficacy: Low (interferons, glatiramer acetate), standard (S1P inhibitors, fumarates), and high (B-cell depleting agents [rituximab, ocrelizumab], natalizumab, cyclophosphamide).
Results:
A total of 135 individuals with POMS were identified. The most common medications initially prescribed were fumarates (n=28, 20.7%) glatiramer acetate (n=22, 16.3%), and B-cell depletion agents (n=18, 13.3%). Younger patients (≤10 years of age) were 16 times more likely to be initially prescribed with a low efficacy DMT (95%CI: 1.79-143.16, p=0.01), whereas older patients were 8.6 times more likely to receive standard/high efficacy DMT (95%CI: 4.78-15.34, p<0.001). Individuals who had more than three or more medication changes were 8.8 times more likely to be obese (95%CI: 1.01-75.77, p=0.048), 11.1 times more likely present with optic neuritis (95%CI: 2.12- 58.19, p=0.004), and have a higher EDSS Score (t= 2.50, p=0.007). During the course of the study, the percentage of patients prescribed high efficacy DMTs at diagnosis increased from 25.92% (n=35) to 48.89% (n=66).
Conclusions:
Individuals with POMS who were started on low efficacy medications were more likely to change DMT, often in the setting of clinical or radiographic relapse. This data supports early and aggressive DMT use in individuals with POMS.