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Abstract Details

Disease Modifying Therapy Utilization in Pediatric Multiple Sclerosis: A Multi-center Retrospective Study
Multiple Sclerosis
P1 - Poster Session 1 (8:00 AM-9:00 AM)

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. 

To evaluate trends in DMT use in individuals with POMS and determine if there were demographic factors that influence utilization.
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).
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).
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.
Amara Miller
Ms. Miller has nothing to disclose.
Heather Held (University of Arizona College of Medicine Phoenix) Ms. Held has nothing to disclose.
Thomas DeCesare Mr. DeCesare has nothing to disclose.
Frederick Bassal, DO (University of California Davis Health Child Neurology) Dr. Bassal has nothing to disclose.
Vaishnavi L. Vaidyanathan, MD Dr. Vaidyanathan has nothing to disclose.
Jonathan Santoro, MD (Department of Neurology, Children's Hospital Los Angeles) Dr. Santoro has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for UCB. Dr. Santoro has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Cycle Pharma.