Disease-modifying therapy and response to first-line treatment in pediatric multiple sclerosis

Pediatric-onset multiple sclerosis (MS) may comprise up to 5% of cases of MS in North America. The natural history of the disease in children is unknown. Although multiple therapies have been developed and approved for the treatment of adult MS, data regarding these therapies in children are limited. Therefore, most treatment decisions are based in part on treatment studies performed in adults. In this chapter, we will review the current literature on disease-modifying therapies (DMT) for children with MS. The chapter will first focus on first-line therapies. We will then move to a discussion of treatment strategies for children experiencing breakthrough disease while on first-line therapies. Escalation therapies for breakthrough disease are discussed in Chapter 11. Four first-line DMTs have been approved for treatment of relapsing–remitting MS in the adult population. They include glatiramer acetate, interferon beta-1a IM, interferon beta-1a SC, and interferon beta-1b SC. Interferon beta Interferon beta is thought to act in MS via inhibition of pro-inflammatory cytokines, induction of anti-inflammatory mediators, reduction of cellular migration, and inhibition of autoreactive T cells [1,2]. Large phase III studies showed that chronic administration of recombinant interferon beta (IFNB) reduced the number of relapses and slowed progression of physical disability in adult patients with RR MS.