Analysis of the efficacy and safety of first- and second-line disease-modifying drugs for multiple sclerosis in treatment of pediatric multiple sclerosis

Background. Moderately effective therapy (MET) is recommended for the treatment of multiple sclerosis (MS) with childhood onset, except when the course is highly active or primary progressive, then highly effective therapy (HET) is used. The results of randomized controlled trials as well as cohort observational studies have shown advantages of HET over MET.Aim. To evaluate the efficacy of first-line disease-modifying drugs in MS in children and compare it with the efficacy of second-line disease-modifying drugs in MS.Materials and methods. On the basis of the paediatric neurology department of the M.F. Vladimirskiy Moscow State Medical Institute a cohort study was conducted that included 50 patients with MS who had experienced their first symptoms during childhood. These patients were receiving disease-modifying therapy for a period of more than one year, and had undergone a total of 87 attempts at therapy. A total of 67 courses of MET (interferon, glatiramer acetate, teriflunomide) and 20 courses of HET (fingolimod, ocrelizumab, rituximab before 18 years of age; natalizumab, ocrelizumab and alemtuzumab after 18 years of age) were administered.Results. The efficacy of MET was 16 % (11 cases out of 67) and of HET was 80 % (16 cases out of 20). In 30 % of cases, the decision to switch from the MET course to the HET course was taken. Significant adverse events occurred in 19 % of cases in the MET group, and in 5 % of cases in the HET group. The frequency of MET drug cancellation was 49 %, while the frequency of HET cancellation was 15 %.Conclusion. In the present study, the efficacy of MET in MS with a childhood onset was found to be 5 times lower than that of HET. Adverse events were observed to occur with a frequency four times higher in the context of MET than in the context of HET. The frequency of treatment discontinuation was found to be more than three times higher in cases of MET than in cases of HET. The results demonstrated that HET was associated with enhanced tolerability and adherence to treatment. Furthermore, emphasis was placed on the underutilisation of HET in children, with the recommendation that its utilisation be expanded at the pediatric onset MS.