Anti-CD20 Therapies Outperform Platform DMTs in Pediatric MS

Anti-CD20 therapies were associated with superior outcomes compared with traditional platform disease-modifying treatments (DMTs) for children with prepubertal-onset multiple sclerosis (MS) according to study results presented at the 41st Congress of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS). Compared with platform therapies (interferons, glatiramer acetate, dimethyl fumarate, or teriflunomide), treatment with anti-CD20 agents resulted in fewer relapses, less lesion accumulation, and reduced brain atrophy. These results suggest that high-efficacy therapies may be a more effective treatment option for individuals with prepubertal MS.

Researchers analyzed outcomes from 46 children with prepubertal-onset MS (mean age, 10.4 years) across 2 centers in the United Kingdom with at least 2 years of follow-up. Sixteen children received anti-CD20 therapies and 30 were treated with platform DMTs. Volumetric MRI brain data were compared with a normative dataset from 317 healthy children. Researchers used statistical modeling approaches—including negative binomial regression and mixed-effects analysis—to compare relapse rates and brain volume changes over time. According to the study authors, the two groups were comparable at baseline in terms of demographics, relapse rates, and brain volume.

Key findings include:

• None of the children treated with anti-CD20 therapies experienced relapses, compared with an annualized relapse rate of 1.1 (standard error [SE]=0.44) in the platform treatment group.
• Anti-CD20 therapy was associated with reduced disability accrual (β=0.71; SE=0.14; P< .001) and a reduction in new lesions (β=0.95; SE=0.42; P=.02).
• Platform treatments were associated with greater lesion volume increase (β=0.32; SE=0.15; P=.05) and cortical (β =−0.42; SE=0.19; P= 0.03), deep grey matter (β=−0.46; SE=0.15; P=.003), and brainstem atrophy (β=−0.26; SE=0.11, P=.02).