Baylor College of Medicine

Author Of 1 Presentation

Pediatric MS Late Breaking Abstracts

LB1243 - Disease modifying treatment changes in pediatric onset multiple sclerosis patients over the past 10 years. A single center retrospective study. (ID 2129)

Speakers
Presentation Number
LB1243
Presentation Topic
Pediatric MS

Abstract

Background

Disease modifying treatments (DMT) in multiple sclerosis (MS) have evolved significantly over the past decade. The expansion of treatment choices provides more options to patients and providers with regards to delivery methods and relapse rate control, however, this also poses new challenges secondary to their side effect profiles. The debate is ongoing in subject to induction versus escalation therapy. The prior proposes initiation of treatments with lower efficacy (lower risk profile) then switching to higher efficacy as needed, whereas the latter recommends immediate higher efficacy treatment. The guidelines to this subject are even less clear in pediatric onset multiple sclerosis patients (POMS).

Objectives

To examine trends of DMT use in POMS patients at a tertiary care center (Baylor College of Medicine/Texas Children’s Hospital) over the past ten years.

Methods

Retrospective chart review via SlicerDicer software was performed looking for POMS patients. Of the initial 239 patients, 124 patients met the following inclusion criteria: diagnosis of MS <18 years of age, ages 0-21 and use of DMT. Data collected: demographics, DMTs used, magnetic resonance imaging findings, expanded disability score status and clinical relapses. Disease progression was defined as the development of new lesions on MRI or a clinical relapse. DMT: injectables-glatiramer acetate, interferons; per os (PO)-fingolimod, dimethyl fumarate, teriflunomide; infusion-rituximab, natalizumab, ocrelizumab.

Results

Of the 124 POMS patients, 41.1% were male and 58.8% were female, with mean age of diagnosis at 15 years (standard deviation +/- 3). 60 patients (48.4%) transitioned DMT during follow up, while 64 (51.6%) remained on their initial medication. Of those who transitioned DMT, 17 switched more than once (totaling 85 switches). 45 switches were due to disease progression (52.9%), whilst 40 were due to side effects and/or noncompliance (47.1%). Of the patients switching DMT due to disease progression, 60% were on injectables, 37.8% on PO and 2.2% on infusions. For those who never switched DMT, 39.7% were on injectables, 33.3% on infusions, and 27% were on PO. 95.45% of patients started on infusions never switched, however 54.84% on PO and 35.71% on injectables switched their DMT. In 2011, 20 patients were on injectables, 14 on PO and 2 on infusions. Whereas in 2020, only 6 patients were on injectables, 8 on PO and 29 on infusions, demonstrating an upward trend in use of infusions. Annual relapse rate (AAR) between 2011-2020 regardless of DMT was 0.13 with a median of 0. The AAR for injectables, orals and infusions were 0.13, 0.17 and 0.026, respectively.

Conclusions

At this tertiary care institution, nearly half of patients with POMS have changed DMT either due to disease progression or side effects. Those on infusion therapies were seen to be more likely to remain on their treatment, have lower ARR and less disease progression compared to other treatment options.

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Presenter Of 1 Presentation

Pediatric MS Late Breaking Abstracts

LB1243 - Disease modifying treatment changes in pediatric onset multiple sclerosis patients over the past 10 years. A single center retrospective study. (ID 2129)

Speakers
Presentation Number
LB1243
Presentation Topic
Pediatric MS

Abstract

Background

Disease modifying treatments (DMT) in multiple sclerosis (MS) have evolved significantly over the past decade. The expansion of treatment choices provides more options to patients and providers with regards to delivery methods and relapse rate control, however, this also poses new challenges secondary to their side effect profiles. The debate is ongoing in subject to induction versus escalation therapy. The prior proposes initiation of treatments with lower efficacy (lower risk profile) then switching to higher efficacy as needed, whereas the latter recommends immediate higher efficacy treatment. The guidelines to this subject are even less clear in pediatric onset multiple sclerosis patients (POMS).

Objectives

To examine trends of DMT use in POMS patients at a tertiary care center (Baylor College of Medicine/Texas Children’s Hospital) over the past ten years.

Methods

Retrospective chart review via SlicerDicer software was performed looking for POMS patients. Of the initial 239 patients, 124 patients met the following inclusion criteria: diagnosis of MS <18 years of age, ages 0-21 and use of DMT. Data collected: demographics, DMTs used, magnetic resonance imaging findings, expanded disability score status and clinical relapses. Disease progression was defined as the development of new lesions on MRI or a clinical relapse. DMT: injectables-glatiramer acetate, interferons; per os (PO)-fingolimod, dimethyl fumarate, teriflunomide; infusion-rituximab, natalizumab, ocrelizumab.

Results

Of the 124 POMS patients, 41.1% were male and 58.8% were female, with mean age of diagnosis at 15 years (standard deviation +/- 3). 60 patients (48.4%) transitioned DMT during follow up, while 64 (51.6%) remained on their initial medication. Of those who transitioned DMT, 17 switched more than once (totaling 85 switches). 45 switches were due to disease progression (52.9%), whilst 40 were due to side effects and/or noncompliance (47.1%). Of the patients switching DMT due to disease progression, 60% were on injectables, 37.8% on PO and 2.2% on infusions. For those who never switched DMT, 39.7% were on injectables, 33.3% on infusions, and 27% were on PO. 95.45% of patients started on infusions never switched, however 54.84% on PO and 35.71% on injectables switched their DMT. In 2011, 20 patients were on injectables, 14 on PO and 2 on infusions. Whereas in 2020, only 6 patients were on injectables, 8 on PO and 29 on infusions, demonstrating an upward trend in use of infusions. Annual relapse rate (AAR) between 2011-2020 regardless of DMT was 0.13 with a median of 0. The AAR for injectables, orals and infusions were 0.13, 0.17 and 0.026, respectively.

Conclusions

At this tertiary care institution, nearly half of patients with POMS have changed DMT either due to disease progression or side effects. Those on infusion therapies were seen to be more likely to remain on their treatment, have lower ARR and less disease progression compared to other treatment options.

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