Skip to main content

Advertisement

SpringerLink
Log in

Two-year follow-up during fingolimod treatment in a pediatric multiple sclerosis patient still active on first-line treatment

  • Brief Communication
  • Published:
Neurological Sciences Aims and scope Submit manuscript

Abstract

Treatment of pediatric multiple sclerosis (MS) has been increasingly debated in the last few years due to limited knowledge of treatment strategies and therapeutic options. When MS develops at a young age, it usually has a very inflammatory disease course, with many relapses and disease activity as seen in magnetic resonance imaging (MRI). Therefore, treatment with immunomodulatory drugs may be beneficial in these patients. However, limited data are available to date on the treatment of pediatric MS. Although observational, prospective, and retrospective studies provide some information on its treatment course, only one clinical trial in pediatric patients has been published, the PARADIGMS trial, which showed an 82% reduction in relapse rate with fingolimod (0.5 mg/day) versus interferon β-1a (30 μg once weekly intramuscularly). Here, we present the case of a pediatric patient with MS (age of onset, 13 years), who was initially treated with interferon β-1a for 2 years and subsequently switched to fingolimod, owing to clinical and radiological activity despite treatment with interferon β-1a.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Data availability

Not applicable

References

  1. Chitnis T (2019) Pediatric central nervous system demyelinating diseases. Continuum (Minneap Minn) 25(3):793–814

    Google Scholar 

  2. Belman AL, Krupp LB, Olsen CS, Rose JW, Aaen G, Benson L et al (2016) Characteristics of children and adolescents with multiple sclerosis. Pediatrics 138(1):e20160120

    Article  Google Scholar 

  3. Absoud M, Lim MJ, Chong WK, De Goede CG, Foster K, Gunny R et al (2013) Paediatric acquired demyelinating syndromes: incidence, clinical and magnetic resonance imaging features. Mult Scler 19(1):76–86

    Article  Google Scholar 

  4. Banwell B, Kennedy J, Sadovnick D, Arnold DL, Magalhaes S, Wambera K, Connolly MB, Yager J, Mah JK, Shah N, Sebire G, Meaney B, Dilenge ME, Lortie A, Whiting S, Doja A, Levin S, MacDonald EA, Meek D, Wood E, Lowry N, Buckley D, Yim C, Awuku M, Guimond C, Cooper P, Grand'Maison F, Baird JB, Bhan V, Bar-Or A (2009) Incidence of acquired demyelination of the CNS in Canadian children. Neurology. 72(3):232–239

    Article  CAS  Google Scholar 

  5. 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(2):186–193

    Article  CAS  Google Scholar 

  6. 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(1):54–59

    Article  Google Scholar 

  7. Malik MT, Healy BC, Benson LA, Kivisakk P, Musallam A, Weiner HL, Chitnis T (2014) Factors associated with recovery from acute optic neuritis in patients with multiple sclerosis. Neurology. 82(24):2173–2179

    Article  Google Scholar 

  8. Fay AJ, Mowry EM, Strober J, Waubant E (2012) Relapse severity and recovery in early pediatric multiple sclerosis. Mult Scler 18(7):1008–1012

    Article  Google Scholar 

  9. Renoux C, Vukusic S, Mikaeloff Y, Edan G, Clanet M, Dubois B, Debouverie M, Brochet B, Lebrun-Frenay C, Pelletier J, Moreau T, Lubetzki C, Vermersch P, Roullet E, Magy L, Tardieu M, Suissa S, Confavreux C (2007) Natural history of multiple sclerosis with childhood onset. N Engl J Med 356(25):2603–2613

    Article  CAS  Google Scholar 

  10. Polman CH, Reingold SC, Banwell B, Clanet M, Cohen JA, Filippi M, Fujihara K, Havrdova E, Hutchinson M, Kappos L, Lublin FD, Montalban X, O'Connor P, Sandberg-Wollheim M, Thompson AJ, Waubant E, Weinshenker B, Wolinsky JS (2011) Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria. Ann Neurol 69(2):292–302

    Article  Google Scholar 

  11. Dale RC, Brilot F, Duffy LV, Twilt M, Waldman AT, Narula S, Muscal E, Deiva K, Andersen E, Eyre MR, Eleftheriou D, Brogan PA, Kneen R, Alper G, Anlar B, Wassmer E, Heineman K, Hemingway C, Riney CJ, Kornberg A, Tardieu M, Stocco A, Banwell B, Gorman MP, Benseler SM, Lim M (2014) Utility and safety of rituximab in pediatric autoimmune and inflammatory CNS disease. Neurology. 83(2):142–150

    Article  CAS  Google Scholar 

  12. Krupp LB, Pohl D, Ghezzi A, Boyko A, Tenembaum S, Chen L, Aycardi E, Banwell B, REPLAY Study Group (2016) Subcutaneous interferon beta-1a in pediatric patients with multiple sclerosis: regional differences in clinical features, disease management, and treatment outcomes in an international retrospective study. J Neurol Sci 363:33–38

    Article  CAS  Google Scholar 

  13. Tenembaum SN, Banwell B, Pohl D, Krupp LB, Boyko A, Meinel M, Lehr L, Rocak S, Cantogno EV, Moraga MS, Ghezzi A, REPLAY Study Group (2013) Subcutaneous interferon beta-1a in pediatric multiple sclerosis: a retrospective study. J Child Neurol 28(7):849–856

    Article  Google Scholar 

  14. Ghezzi A, Moiola L, Pozzilli C, Brescia-Morra V, Gallo P, Grimaldi LM et al (2015) Natalizumab in the pediatric MS population: results of the Italian registry. BMC Neurol 15:174

    Article  Google Scholar 

  15. Ghezzi A, Pozzilli C, Grimaldi LM, Moiola L, Brescia-Morra V, Lugaresi A, Lus G, Rinaldi F, Rocca MA, Trojano M, Bianchi A, Comi G, Filippi M, the Italian MS Study Group (2013) Natalizumab in pediatric multiple sclerosis: results of a cohort of 55 cases. Mult Scler 19(8):1106–1112

    Article  CAS  Google Scholar 

  16. 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(11):1017–1027

    Article  CAS  Google Scholar 

  17. Plavina T, Subramanyam M, Bloomgren G, Richman S, Pace A, Lee S, Schlain B, Campagnolo D, Belachew S, Ticho B (2014) Anti-JC virus antibody levels in serum or plasma further define risk of natalizumab-associated progressive multifocal leukoencephalopathy. Ann Neurol 76(6):802–812

    Article  CAS  Google Scholar 

  18. Krysko KM, Graves JS, Rensel M, Weinstock-Guttman B, Rutatangwa A, Aaen G, Belman A, Benson L, Chitnis T, Gorman M, Goyal MS, Harris Y, Krupp L, Lotze T, Mar S, Moodley M, Ness J, Rodriguez M, Rose J, Schreiner T, Tillema JM, Waltz M, Casper TC, Waubant E, the US Network of Pediatric MS Centers (2020) Real-world effectiveness of initial disease-modifying therapies in pediatric multiple sclerosis. Ann Neurol 88(1):42–55

    Article  CAS  Google Scholar 

  19. Ho PR, Koendgen H, Campbell N, Haddock B, Richman S, Chang I (2017) Risk of natalizumab-associated progressive multifocal leukoencephalopathy in patients with multiple sclerosis: a retrospective analysis of data from four clinical studies. Lancet Neurol 16(11):925–933

    Article  CAS  Google Scholar 

  20. Filippi M, Rocca MA, Bastianello S, Comi G, Gallo P, Gallucci M, Ghezzi A, Marrosu MG, Minonzio G, Pantano P, Pozzilli C, Tedeschi G, Trojano M, Falini A, de Stefano N, Neuroimaging and MS Study Groups of the Italian Society of Neurology, Functional Neuroradiology Section of the Italian Association of Neuroradiology (2013) Guidelines from The Italian Neurological and Neuroradiological Societies for the use of magnetic resonance imaging in daily life clinical practice of multiple sclerosis patients. Neurol Sci 34(12):2085–2093

    Article  Google Scholar 

  21. Rotstein DL, Healy BC, Malik MT, Chitnis T, Weiner HL (2015) Evaluation of no evidence of disease activity in a 7-year longitudinal multiple sclerosis cohort. JAMA Neurol 72(2):152–158

    Article  Google Scholar 

Download references

Acknowledgments

The authors thank Dr. Paola de Mitri and Dr. Stefano Vollaro for clinical support during the discussion of the presented clinical case. The authors also thank Nishad Parkar, PhD, of Springer Healthcare Communications for providing assistance in editing and styling the manuscript before submission. This medical writing assistance was funded by Novartis Farma, Italy.

Author information

Authors and Affiliations

  1. Neurology Unit, Guglielmo da Saliceto Civil Hospital, Via Giuseppe Taverna 49, 29121, Piacenza, Italy

    Paolo Immovilli, Nicola Morelli & Donata Guidetti

  2. Neurology Unit, San Giacomo Hospital, ASL AL, Novi Ligure, Italy

    Eugenia Rota

Authors
  1. Paolo Immovilli
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Eugenia Rota
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nicola Morelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Donata Guidetti
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Drs. Immovilli, Rota, Morelli, and Guidetti were involved in the preparation of the manuscript drafts, and read and approved the final draft before submission.

Corresponding author

Correspondence to Paolo Immovilli.

Ethics declarations

Conflict of interest

Dr. Immovilli has received honoraria as a speaker and advisory board member from TEVA, Merck, Biogen, and Roche. Drs Rota, Morelli, and Guidetti have no conflicts of interest to declare.

Ethical approval

Ethical approval was obtained from the local ethics committee of the Guglielmo da Saliceto Civil Hospital in Piacenza, Italy.

Informed consent

Informed consent to participate was obtained from legal guardians. Informed consent to publish was obtained from legal guardians.

Code availability

Not applicable

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Immovilli, P., Rota, E., Morelli, N. et al. Two-year follow-up during fingolimod treatment in a pediatric multiple sclerosis patient still active on first-line treatment. Neurol Sci 42 (Suppl 1), 15–18 (2021). https://doi.org/10.1007/s10072-021-05058-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10072-021-05058-9

Keywords

Search

Navigation