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Review
. 2025 Feb 20;12(3):259.
doi: 10.3390/children12030259.

Therapeutic Advances in Pediatric Multiple Sclerosis

Rachel Walsh  1   2 , Tanuja Chitnis  1   2
Affiliations
Review

Therapeutic Advances in Pediatric Multiple Sclerosis

Rachel Walsh et al. Children (Basel). .

Abstract

Pediatric-onset multiple sclerosis (POMS) is a chronic, immune-mediated disorder that affects the central nervous system in children and adolescents. Approximately 3-10% of MS patients have an onset that occurs before the age of 18. The vast majority of pediatric MS cases are characterized by a relapsing-remitting course with a high burden of disease activity. Pediatric MS patients were historically treated off-label with varying degrees of success. With the approval of many new therapies for adult-onset MS, alternative treatments in pediatric MS have rapidly started to emerge. In this narrative review, we will discuss therapeutic advancements in pediatric multiple sclerosis, including the seminal trials of PARADIGMS, which evaluated fingolimod use in pediatric MS patients, CONNECT (dimethyl fumarate), TERIKIDS (teriflunomide), OPERETTA I (ocrelizumab), and LEMKIDS (alemtuzumab). We will also review the safety and efficacy of different monoclonal antibodies that are commonly prescribed for multiple sclerosis. We will then examine induction versus escalation treatment strategies and conclude with discussions on treatment considerations in POMS patients.

Keywords: EDSS; PIRA; RAW; disease-modifying therapy; pediatric multiple sclerosis; pediatric-onset multiple sclerosis (POMS).

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Conflict of interest statement

R.W. declares no conflict of interest. T.C. has received compensation for consulting from Bristol Myers Squibb, Cabaletta Bio, Cycle Pharmaceuticals*, Genentech, Janssen, Merck KGaA, MJH Life Sciences, Novartis Pharmaceuticals AG, Novartis Pharmaceuticals KK, Octave Bioscience, F.Hoffmann-La Roche Ltd., Sanofi, Siemens*, and UCB Biopharma*. T.C. has received compensation for speaking engagements from Intellisphere, LLC* and Prime Education, LLC*. T.C. has received research support from the BrightFocus Foundation, Bristol Myers Squibb, Genentech, EMD Serono, I-Mab Biopharma, Massachusetts Life Sciences Center, National Institutes of Health, National MS Society, Novartis Pharmaceuticals, Octave Bioscience, Sanofi Genzyme, Tiziana Therapeutics, US Department of Defense, and Wesley Clover International. All activities and funding have occurred within the past 24 months (* relationship has since ended), and these disclosures do not conflict with the work being presented.

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