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Time to relapse is comparable in pediatric- and adult-onset multiple sclerosis patients after the initiation of disease-modifying therapy
Author(s): ,
B.F. Décard
Affiliations:
Neurologic Clinic and Policlinic, University and University Hospital Basel, Basel
,
V. von Wyl
Affiliations:
Department of Epidemiology, University of Zürich, Epidemiology, Biostatistics and Prevention Institute, Zürich
,
P. Benkert
Affiliations:
Clinical Trial Unit, Universitätsspital Basel, University Basel, Basel
,
J. Lorscheider
Affiliations:
Neurologic Clinic and Policlinic, University and University Hospital Basel, Basel
,
P. Hänni
Affiliations:
Swiss Association for Joint Tasks of Health Insurances (SVK), Solothurn
,
C. Lienert
Affiliations:
Neurology, Rheinburg Klinik, CH- Walzenhausen, Switzerland
,
J. Kuhle
Affiliations:
Neurologic Clinic and Policlinic, University and University Hospital Basel, Basel
,
T. Derfuss
Affiliations:
Neurologic Clinic and Policlinic, University and University Hospital Basel, Basel
,
L. Kappos
Affiliations:
Neurologic Clinic and Policlinic, University and University Hospital Basel, Basel
Ö. Yaldizli
Affiliations:
Neurologic Clinic and Policlinic, University and University Hospital Basel, Basel
ECTRIMS Online Library. Décard B. Oct 12, 2018; 228834
Bernhard F. Décard
Bernhard F. Décard
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Abstract: P992

Type: Poster Sessions

Abstract Category: Clinical aspects of MS - Paediatric MS

Introduction: Natural history studies show higher relapses rates (RR) in pediatric-onset multiple sclerosis (POMS) compared with adult-onset (AO)MS patients. Whether this is true after the initiation of disease-modifying therapy (DMT) is unclear.
Aim: To compare relapse and disability progression rates in a treated POMS population with AOMS patients matched for demographics and disease characteristics at DMT initiation.
Methods: The data derived from the Swiss national MS treatment registry administered by the Swiss association for joint tasks of health insurances (SVK) including clinical data from 14726 MS patients who started first-line DMT between Jan 1995 and Sep 2017. Disability progression was defined as an increase of the Expanded Disability Status Scale (EDSS) score by 1.0 step (0.5 step, if previous EDSS was ≥5.5) compared to the year before and confirmed 1 year later or by 1.5 step if baseline EDSS was 0. The groups were matched at DMT initiation for gender, disease duration, EDSS, DMT (interferon-β /glatirameracetate vs. orals/intravenous DMT), year of DMT initiation and RR in the 2 years prior to DMT initiation. Data were analyses by means of Kaplan-Meier plots and Cox proportional hazards models.
Results: 364/14726 (2.5%) patients who started first-line DMT had a disease onset at an age < 18 years (y). Baseline characteristics at DMT initiation were 67% female, median age 18y (interquartile range [IQR] 17-24), disease duration 1.4y (IQR 0.4-9.4), number of relapses within two years prior to DMT initiation 1 (IQR 1-2) and EDSS 2.0 (IQR 1.5-3.0). The matching procedure retained 201/364 POMS and 201/14362 AOMS patients followed-up for 6.3y (median). Time to relapse after DMT initiation was similar in both groups (log rank p=0.48). After 3y and 5y of DMT 59% [95% Confidence Interval: 52;66] and 68% [61;74] POMS vs. 54% [47;61] and 65% [58;72] AOMS patients experienced a relapse, respectively (confounder-adjusted HR 1.05 [0.83;1.31], p=0.44). Disability progression was slower in POMS compared with AOMS patients (confounder-adjusted HR 0.6 [0.41;0.86], p=0.013). After 3y and 5y, 11% [8;17] and 19% [14;26] in the POMS group and 18% [13;24] and 34% [27;42] of in AOMS group experienced disability progression.
Conclusion: POMS patients had similar relapse rates compared with a matched AOMS group after DMT initiation.
Disclosure: Bernhard Décard received travel support and / or fees for the institution (University Hospital Basel) from advisory boards or speaker fees from Allmirall, Biogen, Genzyme, Roche, Teva and Novartis, that were used exclusively for research support.
LK's institution (University Hospital Basel) received and used exclusively for research support: steering committee, advisory board, and consultancy fees from Actelion, Addex, Bayer HealthCare, Biogen, Biotica, Celgene/Receptos, Genzyme, Lilly, Merck, Mitsubishi, Novartis, Ono Pharma, Pfizer, Sanofi, Santhera, Siemens, Teva, UCB, Xenoport; speaker fees from Bayer HealthCare, Biogen, Merck, Novartis, Sanofi, Teva; support of educational activities from Bayer HealthCare, Biogen, CSL Behring, Genzyme, Merck, Novartis, Sanofi, Teva; grants from Bayer HealthCare, Biogen, F. Hoffmann-La Roche Ltd, Merck, Novartis, the European Union, the Roche Research Foundations, the Swiss Multiple Sclerosis Society, the Swiss National Research Foundation. Jens Kuhle received speaker fees, research support, travel support, and/or served on advisory boards by ECTRIMS, Swiss MS Society, Swiss National Research Foundation, (320030_160221), University of Basel, Bayer, Biogen, Genzyme, Merck, Novartis, Protagen AG, Roche, Teva.
ÖY's institution University Hospital Basel received grants from ECTRIMS/MAGNIMS, University of Basel, Pro Patient Stiftung University Hospital Basel, Free Academy Basel, Swiss Multiple Sclerosis Society and advisory board fees from Sanofi Genzyme and Novartis Poland exclusively used for support of research and educational activities.
Other authors no conflicts of interest with this work.

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