title: Rituximab in paediatric onset multiple sclerosis: a case series.
abstract: Paediatric onset multiple sclerosis (POMS) is characterized by high inflammatory activity. No disease modifying treatment has been approved for POMS. The objective of this report was to report the use of rituximab, a B cell depleting monoclonal anti-CD20-antibody, in POMS. This is a retrospective case series at four specialized MS centres in Sweden. Participants were identified through the Swedish MS-registry and our own patient stocks. Data were collected through medical charts review. We identified 14 POMS patients treated with i.v. rituximab 500-1000 mg every 6th to 12th months. Median age at disease onset was 14.7 years, median age at rituximab treatment initiation was 16.5 years, and median treatment duration was 23.6 months. No relapses were reported, and the EDSS scores remained stable or decreased in 13 of 14 cases during rituximab treatment. Beyond 6 months from initiating rituximab treatment, only one new lesion was detected on MRI. No serious AEs were reported. The drug survival was 86%. Our data indicate that rituximab treatment is safe, effective and well tolerated in children with MS. Nine POMS cases treated with rituximab have previously been published. They had higher disease activity pre-rituximab, but similar safety and efficacy outcomes after treatment. An RCT of rituximab in POMS is warranted.
authors.affiliation: Department of Pharmacology and Clinical Neuroscience, Section of Neurology, Umeå University, 90187, Umeå, Sweden. jonatan.salzer@umu.se.
authors.forename: Jonatan
authors.initials: J
authors.lastname: Salzer
authors.affiliation: Department of Clinical Neuroscience and Rehabilitation, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Jan
authors.initials: J
authors.lastname: Lycke
authors.affiliation: Department for Women's and Children's Health, Neuropaediatric Unit, Karolinska Institute, Stockholm, Sweden.
authors.forename: Ronny
authors.initials: R
authors.lastname: Wickström
authors.affiliation: Department of Neurology, Institute of Neuroscience, Uppsala University, Uppsala, Sweden.
authors.forename: Hans
authors.initials: H
authors.lastname: Naver
authors.affiliation: Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.
authors.forename: Fredrik
authors.initials: F
authors.lastname: Piehl
authors.affiliation: Department of Pharmacology and Clinical Neuroscience, Section of Neurology, Umeå University, 90187, Umeå, Sweden.
authors.forename: Anders
authors.initials: A
authors.lastname: Svenningsson
mesh_terms: D000293:Adolescent; D017668:Age of Onset; D002648:Child; D005260:Female; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D008279:Magnetic Resonance Imaging; D008297:Male; D009103:Multiple Sclerosis / Q000188:drug therapy* / Q000473:pathology; D012042:Registries; D012189:Retrospective Studies; D000069283:Rituximab / Q000627:therapeutic use*; D013548:Sweden
chemical_list: D007155:Immunologic Factors; D000069283:Rituximab
keywords: Immunomodulatory treatment; Observational study; Paediatric onset multiple sclerosis; Rituximab