Monoclonal Antibody Therapy in Childhood Helps Reduce Long-Term MS Disability

Monoclonal antibody therapy initiated during childhood vs early adulthood results in reduced disability in pediatric-onset multiple sclerosis (MS), according to study results presented at the 40th Congress of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS), held in Copenhagen, Denmark, from September 18 to 20, 2024.

Children with MS typically do not receive highly effective monoclonal antibody treatments until adulthood, because of regulatory restrictions. However, researchers hypothesized that these therapies may be beneficial when initiated in childhood.

Researchers sought to evaluate the long-term disability in children with MS who received monoclonal antibodies at different stages of life.

The researchers identified participants for the study from the French MS Registry, the Italian MS Registry, and the global MSBase Registry. Eligibility criteria included age younger than age 18; follow-up at least until age 23; and initiation of monoclonal antibodies, including ocrelizumab, rituximab, or natalizumab, between ages 12 and 17 (childhood/early group) or between 20 and 22 (early adulthood/late group). Baseline clinical and demographic data were collected at age 18. 

Primary study outcome was difference in disability scores, measured using the Expanded Disability Status Scale (EDSS) from baseline until age 27.

A total of 282 patients with pediatric-onset MS were included in the study, of whom 110 (39%) initiated monoclonal antibody treatment during childhood and 172 during early adulthood. At baseline, median EDSS score was 1.5 (1.0-2.5) in the early group vs 1.3 (0.0-2.0) in the late group. Median follow-up was 10.8 years (8.5-14.0 years).

The researchers observed lower disability in patients who received monoclonal antibodies in childhood vs those who received these therapies during early adulthood (β, -0.57; 95% CI, -0.90 to -0.23), with the benefit of early treatment continuing through the follow-up period. Mean absolute differences in EDSS scores from baseline were 0.40 and 0.95 in the early and late group, respectively.

“Early treatment with these highly effective therapies, before the onset of significant neurological impairments, appears crucial for preserving neurological function in children with relapsing-remitting MS over the long-term,” the researchers wrote. They added, “Regulatory access to high-efficacy therapies in children should be streamlined.”

Multiple study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of the authors’ disclosures.