Differences in Effective Therapies for Pediatric versus Adults with MS: Brenda Banwell, MD

WATCH TIME: 5 minutes

“One has to have a very frank and honest conversation and a level of trust between the clinician, the patient, and the communication strategy with the family to be sure that a medication that requires adherence is the right fit for that child.”

In 2018, the FDA made a groundbreaking decision, approving fingolimod (Gilenya; Novartis) as the first therapy specifically to treat pediatric patients with multiple sclerosis (MS) age 10 years and older. An oral presentation on fingolimod’s superior efficacy in comparison with interferon (IFN) β-1a for patients with pediatric MS (PedMS) from the PARADIGMS trial (NCT01892722) was given at the 2022 European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) Congress, from October 26-28, in Amsterdam, Netherlands, by Brenda Banwell, MD, and colleagues.¹

The randomized trial included 215 patients with PedMS that were treated with fingolimod for up to 2 years and followed up by a 5-year, open-label expansion phase (EP) (n = 171). The patients received a 0.5 mg/d or 0.25 mg/d dose of fingolimod based on their body weight as those who were more than 40 kg received 0.5 mg/d.

Those who continued fingolimod through the open-label extension had an adjusted annualized relapse rate (ARR) of 0.11 (95% CI, 0.08 -0.16) while those who switched from interferon ß-1a demonstrated ARRs of 0.34 (95% CI, 0.25, 0.47). The most commonly reported adverse events, found in more than 20% of each treatment arm, were nasopharyngitis (43.5%), headache (34.1%), leukopenia (25.3%), and upper respiratory tract infection (21.2%).

In an interview with NeurologyLive^®, Banwell, chief of neurology, codirector of the neuroscience Center, The Children's Hospital of Philadelphia, professor of neurology and Pediatrics, the University of Pennsylvania, spoke about the conversations with pediatric patients with MS and their parents on effective therapies. Additionally, she talked about how the conversations differ from adults with MS and how to weigh the risk/benefit profiles of each therapy between the two populations.

REFERENCES
1. Deiva K, Banwell B, Gärtner J. Long-term efficacy and safety of fingolimod in paediatric multiple sclerosis patients: analysis of PARADIGMS study up to 6 years of treatment. Presented at: 2022 ECTRIMS Congress; October 26-28; Amsterdam, Netherlands. Oral Presentation 69