Pediatric onset multiple sclerosis (POMS) account for 5-10% of all MS cases. The optimal treatment target in POMS is not known. No Evidence of Disease Activity (NEDA), defined as the lack of clinical and radiologic evidence of MS activity, has been proposed as a possible outcome measure and treatment target in MS.
We aim to determine POMS NEDA rate, compare NEDA and evidence of disease activity (EDA) patient characteristics, and determine NEDA predictors.
Retrospective analyses of POMS cases from the Multiple Sclerosis and other Demyelinating Diseases Database (PedMSDD) were conducted. Multiple imputation was employed to reduce bias relative to complete-case methods. NEDA proportions at 12, 18, and 24 months post-diagnosis were calculated. Demographic and clinical disease characteristics between NEDA and EDA were compared. The odds of achieving NEDA at each time interval were modeled using separate univariable logistic regressions, and significant predictors were included in final multivariable models.
Demographics and clinical characteristics were similar between NEDA and EDA. In patients with at least six months of follow-up (N=913), an estimated 56%, 64%, and 69% of patients achieve NEDA at months 12, 18, and 24, respectively. A significant proportion (>70%) of patients were not on disease modifying therapy (DMT) in the first 6 months. Among those on DMT, intravenous (IV) DMT was more common among the NEDA group compared to EDA. Recent DMT use was more important than initial DMT use in its ability to explain NEDA status at 18 and 24 months. Those on IV DMT had increased odds of achieving NEDA compared to those on no DMT or other DMTs.
A majority of POMS patients achieved NEDA at some point within 2 years of MS diagnosis, despite being treatment-naïve initially. In those on DMT, recent intravenous DMT use was associated with higher likelihood of NEDA.