Paediatric multiple sclerosis: a lesson from TERIKIDS

Abstract

Biological plausibility and convincing evidence from subgroup analyses indicate that the treatments proven efficacious for adults with multiple sclerosis are generally as effective, or more, in patients who are younger and have more active disease; 1 Signori A Schiavetti I Gallo F Sormani MP Subgroups of multiple sclerosis patients with larger treatment benefits: a meta-analysis of randomized trials. Eur J Neurol. 2015; 22: 960-966 Google Scholar such findings give a rationale for use of these drugs in paediatric multiple sclerosis. To put it another way, there is no apparent reason why effective treatments for adults who have relapsing-remitting multiple sclerosis should be not effective in children. Arguably the most important requirement to advance the care of paediatric patients with multiple sclerosis is the assessment of long-term safety, to ensure that treatment during childhood and adolescence does not expose patients to future risk. The ways in which the safety and efficacy of drugs might be investigated in patients with paediatric multiple sclerosis have been discussed extensively in a consensus paper from the International Paediatric Multiple Sclerosis Study Group (IPMSSG). 2 Waubant E Banwell B Wassmer E et al. Clinical trials of disease-modifying agents in pediatric MS: opportunities, challenges, and recommendations from the IPMSSG. Neurology. 2019; 92: e2538-e2549 Google Scholar Safety and efficacy of teriflunomide in paediatric multiple sclerosis (TERIKIDS): a multicentre, double-blind, phase 3, randomised, placebo-controlled trialNo significant difference in time to first confirmed clinical relapse was found, possibly because more patients than expected switched from the double-blind to the open-label treatment period because of high MRI activity. Key secondary imaging analyses and a prespecified sensitivity analysis of probability of relapse or high MRI activity suggest that teriflunomide might have beneficial effects in children with relapsing multiple sclerosis by reducing the risk of focal inflammatory activity. Full-Text PDF