Charalampos Skarlis1, Nikolaos Markoglou1, Maria Gontika1, Anastasia Bougea2, Serafeim Katsavos1, Artemios Artemiadis1, George Chrousos3, Marinos Dalakas4,5, Leonidas Stefanis2, Maria Anagnostouli6,7,8. 1. Research Immunogenetics Laboratory, 1st Department of Neurology, Medical School, National and Kapodistrian University of Athens, Aeginition University Hospital, Athens, Greece. 2. 1st Department of Neurology, Medical School, National and Kapodistrian University of Athens, NKUA, Aeginition University Hospital, Vassilisis Sofias Ave 72-74, 11528, Athens, Greece. 3. Aghia Sophia Children's Hospital, University Research Institute of Maternal and Child Health and Precision Medicine and UNESCO Chair On Adolescent Health Care, National and Kapodistrian University of Athens, 11527, Athens, Greece. 4. Neuroimmunology Unit, Department of Pathophysiology, National and Kapodistrian University of Athens, Athens, Greece. 5. Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA. 6. Research Immunogenetics Laboratory, 1st Department of Neurology, Medical School, National and Kapodistrian University of Athens, Aeginition University Hospital, Athens, Greece. managnost@med.uoa.gr. 7. 1st Department of Neurology, Medical School, National and Kapodistrian University of Athens, NKUA, Aeginition University Hospital, Vassilisis Sofias Ave 72-74, 11528, Athens, Greece. managnost@med.uoa.gr. 8. Multiple Sclerosis and Demyelinating Diseases Unit, 1st, Department of Neurology, Medical School, National and Kapodistrian University of Athens, Aeginition University Hospital, Athens, Greece. managnost@med.uoa.gr.
Abstract
OBJECTIVES: Long-term immunomodulatory therapy of pediatric onset-multiple sclerosis (POMS) is based mainly on published case series and internationally agreed guidelines. Relevant studies in the Greek population are absent from the literature. The purpose of this study is to present data on the efficacy and safety of the 1st line immunomodulatory drugs in the treatment of POMS patients. MATERIALS AND METHODS: The present study included 27 patients meeting the IPMSSG criteria for POMS and who are monitored at the outpatient clinic of the Multiple Sclerosis and Demyelinating Diseases Unit (MSDDU), of the 1st Neurological Department, University Hospital of Aeginition. All patients received 1st line immunomodulatory drugs as initial therapy. Clinical, laboratory, and imaging parameters of the disease were recorded before and after treatment. RESULTS: Post-treatment, a significant reduction of the relapse number (mean ± SD: 2.0 ± 1.0 vs 1.2 ± 1.6, p = 0.002), EDSS progression (mean ± SD: 1.5 ± 0.8 vs 0.9 ± 0.7, p = 0.005) and ARR (mean ± SD: 1.5 ± 0.7 vs 0.4 ± 0.5, p = 0.0001) was observed, while no changes were observed in the EDSS score, (mean ± SD: 1.8 ± 0.6 vs 1.9. 0.6, p = 0.60). Advanced age at treatment initiation increased the risk for drug discontinuation before 24 months of therapy (HR = 0.6, 95% CI (0.35-0.99), p = 0.04). CONCLUSIONS: Most pediatric patients are forced to switch to either more efficacious 1st line or 2nd line drugs. Additionally, our study suggests that older age at the time of the 1st line treatment initiation, contributes to earlier drug discontinuation.
OBJECTIVES: Long-term immunomodulatory therapy of pediatric onset-multiple sclerosis (POMS) is based mainly on published case series and internationally agreed guidelines. Relevant studies in the Greek population are absent from the literature. The purpose of this study is to present data on the efficacy and safety of the 1st line immunomodulatory drugs in the treatment of POMS patients. MATERIALS AND METHODS: The present study included 27 patients meeting the IPMSSG criteria for POMS and who are monitored at the outpatient clinic of the Multiple Sclerosis and Demyelinating Diseases Unit (MSDDU), of the 1st Neurological Department, University Hospital of Aeginition. All patients received 1st line immunomodulatory drugs as initial therapy. Clinical, laboratory, and imaging parameters of the disease were recorded before and after treatment. RESULTS: Post-treatment, a significant reduction of the relapse number (mean ± SD: 2.0 ± 1.0 vs 1.2 ± 1.6, p = 0.002), EDSS progression (mean ± SD: 1.5 ± 0.8 vs 0.9 ± 0.7, p = 0.005) and ARR (mean ± SD: 1.5 ± 0.7 vs 0.4 ± 0.5, p = 0.0001) was observed, while no changes were observed in the EDSS score, (mean ± SD: 1.8 ± 0.6 vs 1.9. 0.6, p = 0.60). Advanced age at treatment initiation increased the risk for drug discontinuation before 24 months of therapy (HR = 0.6, 95% CI (0.35-0.99), p = 0.04). CONCLUSIONS: Most pediatric patients are forced to switch to either more efficacious 1st line or 2nd line drugs. Additionally, our study suggests that older age at the time of the 1st line treatment initiation, contributes to earlier drug discontinuation.
Authors: Frederik Bartels; Katharina Nobis; Graham Cooper; Eva Wendel; Robert Cleaveland; Barbara Bajer-Kornek; Astrid Blaschek; Mareike Schimmel; Markus Blankenburg; Matthias Baumann; Michael Karenfort; Carsten Finke; Kevin Rostásy Journal: Mult Scler Date: 2019-04-04 Impact factor: 6.312
Authors: Asya I Wallach; Michael Waltz; T Charles Casper; Gregory Aaen; Anita Belman; Leslie Benson; Tanuja Chitnis; Mark Gorman; Jennifer Graves; Yolanda Harris; Timothy E Lotze; Soe Mar; Manikum Moodley; Jayne M Ness; Mary Rensel; Moses Rodriguez; John W Rose; Teri Schreiner; Jan-Mendelt Tillema; Emmanuelle Waubant; Bianca Weinstock-Guttman; Leigh E Charvet; Lauren B Krupp Journal: Mult Scler Date: 2019-11-28 Impact factor: 6.312
Authors: Tanuja Chitnis; Greg Aaen; Anita Belman; Leslie Benson; Mark Gorman; Manu S Goyal; Jennifer S Graves; Yolanda Harris; Lauren Krupp; Timothy Lotze; Soe Mar; Jayne Ness; Mary Rensel; Teri Schreiner; Jan-Mendelt Tillema; Emmanuelle Waubant; Bianca Weinstock-Guttman; Shelly Roalstad; John Rose; Howard L Weiner; T Charles Casper; Moses Rodriguez Journal: Brain Date: 2020-09-01 Impact factor: 13.501
Authors: Kyla A McKay; Ali Manouchehrinia; Lindsay Berrigan; John D Fisk; Tomas Olsson; Jan Hillert Journal: JAMA Neurol Date: 2019-09-01 Impact factor: 18.302