Abstract
Pediatric-onset multiple sclerosis (MS) has a highly active and aggressive course, which can have a devastating effect on the physical and cognitive functioning of a child if not treated appropriately with effective disease-modifying drugs. The optimal treatment strategy of pediatric MS is currently unknown and debate continues as to whether treatment escalation or initiation of a highly active therapy provides a better outcome. Here, we present the case of a 16-year-old female diagnosed with highly active relapsing-remitting MS (age at onset: 14 years) who received first-line treatment with fingolimod within 1 year of the first recorded symptom. Since starting fingolimod, the course of the disease has essentially been stable. No new or active lesions were observed in magnetic resonance imaging scans performed at 3 and 12 months after starting fingolimod, and treatment was well tolerated. These data suggest that, in this case, early treatment with first-line fingolimod was able to slow disease progression.
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References
Narula S, Hopkins SE, Banwell B (2015) Treatment of pediatric multiple sclerosis. Curr Treat Options Neurol 17:336. https://doi.org/10.1007/s11940-014-0336-z
Wang CX, Greenberg BM (2018) Pediatric multiple sclerosis: from recognition to practical clinical management. Neurol Clin 36:135–149. https://doi.org/10.1016/j.ncl.2017.08.005
Alroughani R, Boyko A (2018) Pediatric multiple sclerosis: a review. BMC Neurol 18:27. https://doi.org/10.1186/s12883-018-1026-3
Waldman A, Ghezzi A, Bar-Or A, Mikaeloff Y, Tardieu M, Banwell B (2014) Multiple sclerosis in children: an update on clinical diagnosis, therapeutic strategies, and research. Lancet Neurol 13:936–948. https://doi.org/10.1016/S1474-4422(14)70093-6
Benson LA, Healy BC, Gorman MP, Baruch NF, Gholipour T, Musallam A, Chitnis T (2014) Elevated relapse rates in pediatric compared to adult MS persist for at least 6 years. Mult Scler Relat Disord 3:186–193. https://doi.org/10.1016/j.msard.2013.06.004
Gorman MP, Healy BC, Polgar-Turcsanyi M, Chitnis T (2009) Increased relapse rate in pediatric-onset compared with adult-onset multiple sclerosis. Arch Neurol 66:54–59. https://doi.org/10.1001/archneurol.2008.505
Renoux C, Vukusic S, Mikaeloff Y, Edan G, Clanet M, Dubois B et al (2007) Natural history of multiple sclerosis with childhood onset. N Engl J Med 356:2603–2613. https://doi.org/10.1056/NEJMoa067597
Julian L, Serafin D, Charvet L, Ackerson J, Benedict R, Braaten E et al (2013) Cognitive impairment occurs in children and adolescents with multiple sclerosis: results from a United States network. J Child Neurol 28:102–107. https://doi.org/10.1177/0883073812464816
Ozturk Z, Gucuyener K, Soysal S, Konuskan GD, Konuskan B, Dikmen AU, Anlar B (2020) Cognitive functions in pediatric multiple sclerosis: 2-years follow-up. Neurol Res 42:159–163. https://doi.org/10.1080/01616412.2019.1710417
Chitnis T, Tenembaum S, Banwell B, Krupp L, Pohl D, Rostasy K et al (2012) Consensus statement: evaluation of new and existing therapeutics for pediatric multiple sclerosis. Mult Scler 18:116–127. https://doi.org/10.1177/1352458511430704
Wassmer E, Chitnis T, Pohl D, Amato MP, Banwell B, Ghezzi A et al (2016) International Pediatric MS Study Group Global Members Symposium report. Neurology 87:S110–S116. https://doi.org/10.1212/WNL.0000000000002880
Krysko KM, Graves J, Rensel M, Weinstock-Guttman B, Aaen G, Benson L et al (2018) Use of newer disease-modifying therapies in pediatric multiple sclerosis in the US. Neurology 91:e1778–e1787. https://doi.org/10.1212/WNL.0000000000006471
Chitnis T, Arnold DL, Banwell B, Bruck W, Ghezzi A, Giovannoni G et al (2018) Trial of fingolimod versus interferon beta-1a in pediatric multiple sclerosis. N Engl J Med 379:1017–1027. https://doi.org/10.1056/NEJMoa1800149
Fisher KS, Cuascut FX, Rivera VM, Hutton GJ (2020) Current advances in pediatric onset multiple sclerosis. Biomedicines 8:71. https://doi.org/10.3390/biomedicines8040071
Deiva K, Huppke P, Banwell B, Chitnis T, Gartner J, Krupp L et al (2020) Consistent control of disease activity with fingolimod versus IFN beta-1a in paediatric-onset multiple sclerosis: further insights from PARADIGMS. J Neurol Neurosurg Psychiatry 91:58–66. https://doi.org/10.1136/jnnp-2019-321124
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The authors thank Melanie Gatt, an independent medical writer on behalf of Springer Healthcare Communications, for providing medical writing assistance and styling the manuscript before submission.
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Support for medical writing and manuscript preparation was funded by Novartis Farma.
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Dr. Capobianco enrolled the patient and performed the whole clinical examination and recorded clinical and instrumental data. He also discussed the results and contributed to the writing of the manuscript for submission. Dr. Antonio Bertolotto revised and approved the manuscript. Dr. Simona Malucchi revised and approved the manuscript.
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Marco Capobianco has received speaking honoraria and personal fees for contributing as an advisory board member from Almirall, Biogen, Merck-Serono, Mylan, Novartis, Roche, Sanofi-Genzyme, and TEVA. Antonio Bertolotto has received speaking honoraria and personal fees for contributing as an advisory board member from Almirall, Biogen, Merck-Serono, Mylan, Novartis, Roche, Sanofi-Genzyme, and TEVA. He also received research grant from Biogen, Novartis, Merck-Serono, Roche, and Sanofi-Genzyme. Simona Malucchi has received speaking honoraria and personal fees for contributing as an advisory board member from Almirall, Biogen, Merck-Serono, Mylan, Novartis, Roche, Sanofi-Genzyme, and TEVA. She also received research grant from Sanofi-Genzyme.
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Ethical approval was obtained from the local ethics committee of the University Hospital San Luigi in Orbassano.
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Capobianco, M., Bertolotto, A. & Malucchi, S. Fingolimod as first-line treatment in pediatric-onset multiple sclerosis: a case report. Neurol Sci 42 (Suppl 1), 25–28 (2021). https://doi.org/10.1007/s10072-020-05027-8
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DOI: https://doi.org/10.1007/s10072-020-05027-8