- MS that starts in childhood is often more active than adult-onset MS, and can have significant impacts within ten years of symptoms starting.
- A new study compared starting highly effective treatments during childhood versus in the early twenties.
- Those who started later experienced greater disability progression, suggesting that earlier treatment may reduce long-term disability.
Childhood MS
Multiple sclerosis (MS) that begins in childhood is rare, but it can have a major impact. Children with MS often have more active disease than adults. There is a high level of inflammation in the brain and spinal cord during these active periods, and they may have more relapses than adults.
At first, children can recover well from these attacks. But repeated relapses can cause damage to accumulate that can result in permanent disability. This can affect mobility, thinking, learning, memory and everyday participation in school, work and social life.
In adults, highly effective therapies such as natalizumab, ocrelizumab and rituximab effectively control inflammation and relapses. Fingolimod is approved for use in children with MS in Australia and is commonly used when starting treatment.
The limitation with this strategy is that it delays access to highly effective treatments, potentially allowing more damage to occur in the meantime.
A new international study led by MS Australia-funded researchers asked whether highly effective treatment, given earlier, could reduce the long-term effects of childhood MS on disability.
Highly effective treatment in childhood: could it reduce long-term disability?
To explore this question, researchers used records from three major MS registries in Europe and Australia.
The team looked at 277 people whose MS began before age 18. Some of these young people started highly effective treatments during childhood (ages 12-17), while others started as young adults, between the ages of 20 and 22.
These treatments included natalizumab, ocrelizumab and rituximab, which are designed to more strongly control the immune activity that drives MS.
The researchers then compared how disability had progressed a few years later, between the ages of 23 and 27.
What was the impact of starting stronger treatment earlier?
To compare earlier and later treatment start, the team looked at how disability changed between age 18 and ages 23 – 27. Their main measure was the Expanded Disability Status Scale (EDSS), the most widely used clinical scale for tracking disability in MS.
The results were encouraging. Young people who started highly effective treatments earlier accumulated less disability than those who started later. On average, the increase in EDSS scores was 0.53 points lower in the early-treatment group than in those who started treatment later. While this difference may seem small, even modest changes in MS can have important real-world impacts over time, particularly when progressing over years.
The benefit was most pronounced in the moderate disability range. Among people with EDSS scores between 4.5 and 6.0, those who began treatment earlier had markedly lower risk of disability worsening. In this disability range, this makes a difference to walking ability and independence. For example, a person with an EDSS of 4.5 may walk without aid or rest for about 300 metres and work a full day with some limitations. An EDSS of 6.0 means a person cannot fulfill full daily activities without assistance and can walk 100 metres with a stick or crutch.
The results suggest that highly effective treatments not only suppress relapses and inflammation but also help preserve function in the longer term.
This adds to the growing evidence that controlling MS early is important, and that waiting until adulthood to use the most effective therapies may come at a long-term cost.
Other things to consider                      Â
The study was not a randomised clinical trial, so it does not conclusively prove cause and effect. It does, however, suggest that the better outcomes are likely to be caused by the earlier treatment.
There was limited information available to the researchers on the safety of the treatments. This meant they were in a better position to look at the effectiveness of the treatments, rather than long-term risks.
They stress that it is essential to keep monitoring safety of the highly effective therapies, especially for children and teenagers who may spend many years on these.
What does this mean for treatment of childhood MS?
Even with these considerations, the study has important implications for doctors, families and policymakers.
Only a limited number of therapies are approved for childhood MS, and highly effective therapies are still not widely accessible for children in many settings around the world.
The study authors argue that improving access to these treatments during childhood could help reduce the long-term impacts of MS on education, employment, participation and quality of life.
In Australia, fingolimod and natalizumab are both subsidised under the Pharmaceutical Benefits Scheme (PBS) for use in children.
Trials of highly effective therapy for MS in children are ongoing. Ocrelizumab was recently shown to be safe and effective in teens with relapsing MS. Early results of a trial in progress have shown relapses and MS lesions only around 50% of that on fingolimod.
For MS care more broadly, the comparison study reflects a changing understanding of what early treatment can achieve. Rather than viewing childhood MS as something to control one relapse at a time, the findings support a more strategic goal: preserving long-term capacity before disability becomes.
