Many of the disease modifying therapies prescribed for adults with MS are also prescribed for pediatric MS. These include conventional first line therapies like interferon beta 1A (Avonex®, Betaseron®) and Glatirimer acetate (Copaxone®). Safety and efficacy of these self-injected disease modifying MS drugs have been demonstrated in small retrospective studies, case studies and unblinded controlled trials (Banwell et al 2006
, Tenenbaum et al 2013
, Kornek et al 2003
). Lack of tolerability or continued progression of disease despite these therapies must prompt use of other newer therapies.
In 2018 the U.S. Food and Drug Administration approved the use of the oral MS therapy fingolimod (Gilenya®, Novartis AG) for treatment of children and adolescents 10 years of age or older with relapsing MS.
Other oral therapies for MS, including dimethyl fumarate (Tecfidera®) and teriflunomide (Aubagio®), are currently under study in clinical trials for the treatment of pediatric MS.
An observational study of natalizumab (Tysabri®) showed that the safety and efficacy in children was similar to that in the adult MS population (Ghezzi et al 2015
In addition to the FDA approved therapies used for pediatrics, another treatment that is not FDA approved for MS, known as rituximab (Rituxan®), has been studied in small trials of pediatric patients and showed that it was safe and effective. Rituximab has been widely used in other pediatric autoimmune disorders and has a favorable safety profile (Dale et al 2014
Ultimately, starting or switching a disease modifying therapy in children and adolescents requires that the provider, child and family have an in-depth discussion. This discussion should include the goals and expectations of the child and family, how the drug is expected to control the MS, the side effects, the risks and any monitoring (blood tests, MRI and other tests) after the therapy is started. In this way, providers, patients and families can participate in a shared decision-making process to determine the therapy that best meets individual needs.
The International Pediatric MS Study Group has written a series of articles, highlighting the advances, unanswered questions and challenges in diagnosing and treating MS in children. These articles have been published in a supplement
to the journal Neurology.
A publication from the MS International Federation (MSIF) summarizes the key points from each of these articles.
In addition to above, in pediatric MS, poor academic performance, difficulty with peer relations, low self esteem, difficulty with acceptance of diagnosis and even depression can be co-existing morbidities. While detailed psychosocial evaluation by a trained professional is warranted, pediatric MS support groups
can provide helpful information, resources and a network for teens and families.
Reviewed by Kavita Thakkar, MD, February 2019