title: Pediatric multiple sclerosis: Escalation and emerging treatments.
abstract: Over the last 20 years, there have been significant advances in multiple sclerosis (MS) therapeutics, with regulatory approval for 13 therapies in adults by the European Medicines Agency (EMA) and Food and Drug Administration. However, there is only limited approval for interferon-β and glatiramer acetate use in children 12 years and older by the EMA. Availability of disease-modifying therapies to children and adolescents with MS is variable by region, and is extremely limited in some regions of the world. Up to 30% of children experience breakthrough disease requiring therapies beyond traditional first-line agents. Recent legislation in both the United States and Europe has mandated clinical studies for all new therapeutics applicable to children. Several clinical trials in children are underway that will provide important information regarding the efficacy and safety of newer drugs. This review summarizes the current knowledge of breakthrough disease, escalation, and induction treatment approaches in children with MS, especially pertaining to disease course and disability outcomes in this group of patients. In addition, ongoing clinical trials and approaches and challenges in conducting clinical trials in the pediatric population are discussed.
authors: From Partners Pediatric MS Center (T.C.), Massachusetts General Hospital, Harvard Medical School, Boston; Divisione di Neurologia 2-Centro Studi Sclerosi Multipla (A.G.), Ospedale di Gallarate, Italy; Department of Neurology (B.B.-K.), Medical University of Vienna, Austria; Department of Neurology, Neurosurgery and Medical Genetics (A.B.), Pirogov's Russian National Research Medical University, Moscow; Barts and The London School of Medicine and Dentistry (G.G.), London, UK; and Department of Neurology (D.P.), Children's Hospital of Eastern Ontario, University of Ottawa, Canada. tchitnis@partners.org.
authors: Tanuja
authors: T
authors: Chitnis
authors: From Partners Pediatric MS Center (T.C.), Massachusetts General Hospital, Harvard Medical School, Boston; Divisione di Neurologia 2-Centro Studi Sclerosi Multipla (A.G.), Ospedale di Gallarate, Italy; Department of Neurology (B.B.-K.), Medical University of Vienna, Austria; Department of Neurology, Neurosurgery and Medical Genetics (A.B.), Pirogov's Russian National Research Medical University, Moscow; Barts and The London School of Medicine and Dentistry (G.G.), London, UK; and Department of Neurology (D.P.), Children's Hospital of Eastern Ontario, University of Ottawa, Canada.
authors: Angelo
authors: A
authors: Ghezzi
authors: From Partners Pediatric MS Center (T.C.), Massachusetts General Hospital, Harvard Medical School, Boston; Divisione di Neurologia 2-Centro Studi Sclerosi Multipla (A.G.), Ospedale di Gallarate, Italy; Department of Neurology (B.B.-K.), Medical University of Vienna, Austria; Department of Neurology, Neurosurgery and Medical Genetics (A.B.), Pirogov's Russian National Research Medical University, Moscow; Barts and The London School of Medicine and Dentistry (G.G.), London, UK; and Department of Neurology (D.P.), Children's Hospital of Eastern Ontario, University of Ottawa, Canada.
authors: Barbara
authors: B
authors: Bajer-Kornek
authors: From Partners Pediatric MS Center (T.C.), Massachusetts General Hospital, Harvard Medical School, Boston; Divisione di Neurologia 2-Centro Studi Sclerosi Multipla (A.G.), Ospedale di Gallarate, Italy; Department of Neurology (B.B.-K.), Medical University of Vienna, Austria; Department of Neurology, Neurosurgery and Medical Genetics (A.B.), Pirogov's Russian National Research Medical University, Moscow; Barts and The London School of Medicine and Dentistry (G.G.), London, UK; and Department of Neurology (D.P.), Children's Hospital of Eastern Ontario, University of Ottawa, Canada.
authors: Alexey
authors: A
authors: Boyko
authors: From Partners Pediatric MS Center (T.C.), Massachusetts General Hospital, Harvard Medical School, Boston; Divisione di Neurologia 2-Centro Studi Sclerosi Multipla (A.G.), Ospedale di Gallarate, Italy; Department of Neurology (B.B.-K.), Medical University of Vienna, Austria; Department of Neurology, Neurosurgery and Medical Genetics (A.B.), Pirogov's Russian National Research Medical University, Moscow; Barts and The London School of Medicine and Dentistry (G.G.), London, UK; and Department of Neurology (D.P.), Children's Hospital of Eastern Ontario, University of Ottawa, Canada.
authors: Gavin
authors: G
authors: Giovannoni
authors: From Partners Pediatric MS Center (T.C.), Massachusetts General Hospital, Harvard Medical School, Boston; Divisione di Neurologia 2-Centro Studi Sclerosi Multipla (A.G.), Ospedale di Gallarate, Italy; Department of Neurology (B.B.-K.), Medical University of Vienna, Austria; Department of Neurology, Neurosurgery and Medical Genetics (A.B.), Pirogov's Russian National Research Medical University, Moscow; Barts and The London School of Medicine and Dentistry (G.G.), London, UK; and Department of Neurology (D.P.), Children's Hospital of Eastern Ontario, University of Ottawa, Canada.
authors: Daniela
authors: D
authors: Pohl
mesh_terms: D002648:Child; D002986:Clinical Trials as Topic; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D009103:Multiple Sclerosis / Q000188:drug therapy* / Q000523:psychology; D010372:Pediatrics; D016896:Treatment Outcome; D014481:United States; D014486:United States Food and Drug Administration
chemical_list: D007155:Immunologic Factors