Long-term disability progression of pediatric-onset multiple sclerosis

Abstract

Objective: To evaluate long-term disability progression in pediatric-onset multiple sclerosis (POMS) and compare to adult-onset multiple sclerosis (AOMS).

Methods: This was a retrospective cohort study using prospectively collected clinical information from the Swedish MS Registry. Clinical features were compared and Kaplan-Meier and Cox proportional hazards regression were used to assess the risk of reaching sustained Expanded Disability Status Scale (EDSS) 3, 4, and 6 in POMS (multiple sclerosis [MS] onset <18 years) and AOMS (MS onset ≥18 years).

Results: A total of 12,482 persons were included; 549 (4.4%) were classified as POMS. The POMS cohort took longer to reach all 3 disability milestones from their MS onset, but did so at a younger age than the AOMS cohort. Primary progressive course (hazard ratio [HR] 4.63; 95% confidence interval [CI] 1.46-14.7), higher relapse rate in the first 5 years of disease (HR 5.35; 95% CI 3.37-8.49), and complete remission from the initial relapse (HR 0.41; 95% CI 0.18-0.94) were associated with an altered risk of progression to EDSS 4 among POMS cases. The same pattern emerged for the risk of reaching EDSS 3 and 6.

Conclusions: Patients with pediatric-onset MS follow a distinctive clinical course, which should be considered in the treatment and management of the disease.

Figure 1. Multiple Sclerosis Severity Scores

Histogram of Multiple Sclerosis Severity Scores based on the first recorded Expanded Disability Status Scale from the (A) pediatric-onset and (B) adult-onset multiple sclerosis cohorts.

Figure 2. Kaplan-Meier survival curves of time from birth and multiple sclerosis (MS) onset to Expanded Disability Status Scale (EDSS) 3 in pediatric-onset multiple sclerosis (POMS) vs adult-onset multiple sclerosis (AOMS)

Time from (A) birth and (B) MS onset to EDSS 3 in POMS vs AOMS.

Figure 3. Kaplan-Meier survival curve of time from birth and multiple sclerosis (MS) onset to Expanded Disability Status Scale (EDSS) 4 in pediatric-onset multiple sclerosis (POMS) vs adult-onset multiple sclerosis (AOMS)

Time from (A) birth and (B) MS onset to EDSS 4 in POMS vs AOMS.

Figure 4. Kaplan-Meier survival curve of time from birth and multiple sclerosis (MS) onset to Expanded Disability Status Scale (EDSS) 6 in pediatric-onset multiple sclerosis (POMS) vs adult-onset multiple sclerosis (AOMS)

Time from (A) birth and (B) MS onset to EDSS 6 in POMS vs AOMS.