By Karla Gale
NEW YORK (Reuters Health) - About half of children with multiple sclerosis (MS) need to switch medication during their first few years of treatment because of refractory illness or poor tolerability, new study results show.
"The general rule of thumb is to wait until more than one relapse has occurred to change therapies," lead author Dr. E. Ann Yeh said. But she advises that physicians shouldn't be afraid to change treatment if the patient's disability worsens or the tempo of relapses increases.
She also recommends that pediatric MS patients be treated as soon as the diagnosis is firm, usually after two clinical episodes of central nervous system demyelination.
In an interview with Reuters Health, the researcher noted that the time to physical disability in kids with MS is longer than in adults, but they "eventually do reach the equivalent to those of adults with secondary progressive MS," and they do so at a younger age. There's also growing evidence that children develop significant cognitive difficulties within several years of diagnosis.
"So if a child is diagnosed with MS, treatment should be initiated sooner rather than later," she said. "Sometimes neurologists tend to wait and watch."
In a paper published online today in the Archives of Neurology, Dr. Yeh, from the Women and Children's Hospital of Buffalo, New York, and colleagues review records of 258 patients with pediatric-onset MS treated between 1997 and 2009 at the six Pediatric MS Centers of Excellence in the US.
The average age of onset was 13.2 years (range 2.0-17.9 years).
The patients initially received at least six months of treatment with a first-line disease-modifying therapy (DMT) - interferon beta (in 77.5%) or glatiramer acetate (in 20.5%). Five patients (1.9%) with very active acute disease were first treated with pulse cyclophosphamide or azathioprine but were later prescribed a first-line DMT.
Most patients (52.3%) continued with the first therapy prescribed throughout the observation period, which averaged 3.9 years. Therapy was changed once in 25.2%, twice in 11.2%, three times in 3.9%, and four or more times in 3.9%. Nine patients (3.5%) quit treatment.