1
|
Teleanu RI, Niculescu AG, Vladacenco OA, Roza E, Perjoc RS, Teleanu DM. The State of the Art of Pediatric Multiple Sclerosis. Int J Mol Sci 2023; 24:ijms24098251. [PMID: 37175954 PMCID: PMC10179691 DOI: 10.3390/ijms24098251] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 04/28/2023] [Accepted: 05/01/2023] [Indexed: 05/15/2023] Open
Abstract
Multiple sclerosis (MS) represents a chronic immune-mediated neurodegenerative disease of the central nervous system that generally debuts around the age of 20-30 years. Still, in recent years, MS has been increasingly recognized among the pediatric population, being characterized by several peculiar features compared to adult-onset disease. Unfortunately, the etiology and disease mechanisms are poorly understood, rendering the already limited MS treatment options with uncertain efficacy and safety in pediatric patients. Thus, this review aims to shed some light on the progress in MS therapeutic strategies specifically addressed to children and adolescents. In this regard, the present paper briefly discusses the etiology, risk factors, comorbidities, and diagnosis possibilities for pediatric-onset MS (POMS), further moving to a detailed presentation of current treatment strategies, recent clinical trials, and emerging alternatives. Particularly, promising care solutions are indicated, including new treatment formulations, stem cell therapies, and cognitive training methods.
Collapse
Affiliation(s)
- Raluca Ioana Teleanu
- "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Pediatric Neurology, "Dr. Victor Gomoiu" Children's Hospital, 022102 Bucharest, Romania
| | - Adelina-Gabriela Niculescu
- Research Institute of the University of Bucharest-ICUB, University of Bucharest, 050657 Bucharest, Romania
- Department of Science and Engineering of Oxide Materials and Nanomaterials, Politehnica University of Bucharest, 011061 Bucharest, Romania
| | - Oana Aurelia Vladacenco
- "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Pediatric Neurology, "Dr. Victor Gomoiu" Children's Hospital, 022102 Bucharest, Romania
| | - Eugenia Roza
- "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Pediatric Neurology, "Dr. Victor Gomoiu" Children's Hospital, 022102 Bucharest, Romania
| | - Radu-Stefan Perjoc
- "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Pediatric Neurology, "Dr. Victor Gomoiu" Children's Hospital, 022102 Bucharest, Romania
| | - Daniel Mihai Teleanu
- "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Neurosurgery, Emergency University Hospital, 050098 Bucharest, Romania
| |
Collapse
|
2
|
Greene N, Araujo L, Campos C, Dalglish H, Gibbs S, Yermilov I. The Economic and Humanistic Burden of Pediatric-Onset Multiple Sclerosis. JOURNAL OF HEALTH ECONOMICS AND OUTCOMES RESEARCH 2022; 9:103-114. [PMID: 36348724 PMCID: PMC9584745 DOI: 10.36469/001c.37992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 08/29/2022] [Indexed: 06/16/2023]
Abstract
Background: Multiple sclerosis (MS) is a chronic inflammatory autoimmune disease of the central nervous system. Pediatric-onset MS (POMS), defined as onset of MS before 18 years of age, is estimated to account for 2% to 5% of the MS population worldwide. Objectives: To conduct a literature review focused on the healthcare resource utilization and cost as well as quality-of-life (QOL) outcomes among patients with POMS. Methods: We conducted a systematic literature review of English-language studies published after September 2010 in MEDLINE and Embase to describe the global economic healthcare resource utilization and costs and humanistic (QOL) burden in patients with POMS. Results: We found 11 studies that reported on healthcare resource utilization, cost, or insurance coverage and 36 studies that reported on QOL outcomes in patients with POMS. Patients with POMS had higher rates of primary care visits (1.41 [1.29-1.54]), hospital visits (10.74 [8.95-12.90]), and admissions (rate ratio, 4.27 [2.92-6.25];OR, 15.2 [12.0-19.1]) compared with healthy controls. Mean per-patient costs in the United States were $5907 across all settings per year of follow-up between 2002 and 2012; mean costs per hospital stay were $38 543 (in 2015 USD) between 2004 and 2013. Three studies reported psychosocial scores between 71.59 and 79.7, and 8 studies reported physical health scores between 74.62 to 82.75 using the Pediatric Quality of Life Measurement Model (PedsQLTM). Twelve studies used the PedsQL™ Multidimensional Fatigue Scale. Mean scores on the self-reported general fatigue scale ranged from 63.15 to 78.5. Quality-of-life scores were lower than those of healthy controls. Discussion: Our review presents a uniquely broad and recent overview of the global economic and humanistic burden of patients with POMS. Additional research on healthcare resource utilization and cost would provide a more robust understanding of the economic burden in this population. Conclusions: Healthcare resource utilization and costs are high in this population, and patients report reduced QOL and significant fatigue compared with healthy children and adolescents.
Collapse
Affiliation(s)
- Nupur Greene
- Health Economics & Value Assessment, Sanofi, Cambridge, Massachusetts
| | - Lita Araujo
- Health Economics & Value Assessment, Sanofi, Cambridge, Massachusetts
| | - Cynthia Campos
- PHAR (Partnership for Health Analytic Research), LLC, Beverly Hills, California
| | - Hannah Dalglish
- PHAR (Partnership for Health Analytic Research), LLC, Beverly Hills, California
| | - Sarah Gibbs
- PHAR (Partnership for Health Analytic Research), LLC, Beverly Hills, California
| | - Irina Yermilov
- PHAR (Partnership for Health Analytic Research), LLC, Beverly Hills, California
| |
Collapse
|
3
|
Ow N, Mozafarinia M, Mayo NE. Quality of life measures in pediatric multiple sclerosis: a systematic review and meta-analysis. Dev Med Child Neurol 2021; 63:1051-1058. [PMID: 33769574 DOI: 10.1111/dmcn.14870] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/25/2021] [Indexed: 12/12/2022]
Abstract
AIM To identify generic measures used to measure quality of life (QoL) in pediatric multiple sclerosis research, estimate an overall score of children and adolescents with pediatric multiple sclerosis, and compare the scores to scores of typically developing children and adolescents. METHOD A systematic search was conducted on four databases. All studies were included if: the sample was children with pediatric demyelinating disorders; self-reported QoL/health-related quality of life (HRQoL) measures or results were reported; and the mean age of the sample was below 21 years. Quality of the included articles was appraised using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist and the Mixed Methods Appraisal Tool checklist. A meta-analysis was also conducted. RESULTS A total of 12 full-text articles were included. Content analysis showed that many components of QoL were not included in the measures. Seven studies were included in the meta-analysis. The meta-analyzed score was 75.7 (95% confidence interval 71.2-80.3) with a pooled standard deviation of 16.6. Scores of typically developing children and children with pediatric multiple sclerosis were similar. INTERPRETATION Most measures assessed HRQoL and not QoL. Development of a condition-specific measure of QoL for children and adolescents with pediatric multiple sclerosis would make an important contribution to the field. What this paper adds Health-related quality of life (HRQoL) measures were used to measure quality of life in pediatric multiple sclerosis. HRQoL scores in pediatric multiple sclerosis were similar to typically developing children and adolescents.
Collapse
Affiliation(s)
- Nikki Ow
- School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, QC, Canada.,Center for Outcomes Research and Evaluation (CORE), The Research Institute of the McGill University Health Center (RI-MUHC), Montreal, QC, Canada
| | - Maryam Mozafarinia
- Center for Outcomes Research and Evaluation (CORE), The Research Institute of the McGill University Health Center (RI-MUHC), Montreal, QC, Canada.,Division of Experimental Medicine, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Nancy E Mayo
- School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, QC, Canada.,Center for Outcomes Research and Evaluation (CORE), The Research Institute of the McGill University Health Center (RI-MUHC), Montreal, QC, Canada.,Division of Experimental Medicine, Faculty of Medicine, McGill University, Montreal, QC, Canada
| |
Collapse
|
4
|
Mrosková S, Klímová E, Majerníková Ľ, Tkáčová Ľ. Quality of Life of Children and Adolescents with Multiple Sclerosis-A Literature Review of the Quantitative Evidence. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168645. [PMID: 34444393 PMCID: PMC8392317 DOI: 10.3390/ijerph18168645] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/03/2021] [Accepted: 08/09/2021] [Indexed: 11/30/2022]
Abstract
Background: Multiple sclerosis (MS) is a chronic disease of the central nervous system that also develops in patients under 18 years of age. The disease negatively affects the quality of life (QoL) of children and adolescents. We conducted a literature review. The aim of the review was to identify the QoL of pediatric patients with MS and assess the factors determining their QoL. Methods: We analyzed studies published between 2000 and 2020 in PubMed, Scopus, Science Direct, Web of Science, and EBSCO databases. Results: In all, 17 studies were included in the review. The most common tool in assessing QoL was the generic module PedsQL. The range of mean/median global score of QoL was 53.8–81.7. The worst QoL was dominantly reported in the school and emotional spheres, on the contrary, the disease’s least determined area of QoL was the social and physical dimension. In particular, disability and fatigue were important predictors of QoL. Conclusions: MS negatively affects the school and emotional spheres in particular, so it is important to pay greater attention to these spheres of life of MS patients. As the review studies pay insufficient attention to the analysis of positive factors and their impact on the QoL of MS patients, research should integrate these phenomena. The use of MS-targeted tools in future research in the pediatric MS population is also appropriate.
Collapse
Affiliation(s)
- Slávka Mrosková
- Department of Nursing, Faculty of Health Care, University of Prešov, Partizánska 1, 08001 Prešov, Slovakia; (Ľ.M.); (Ľ.T.)
- Correspondence: ; Tel.: +421-51-75-62-462
| | - Eleonóra Klímová
- Department of Physiotherapy, Faculty of Health Care, University of Prešov, Partizánska 1, 08001 Prešov, Slovakia;
| | - Ľudmila Majerníková
- Department of Nursing, Faculty of Health Care, University of Prešov, Partizánska 1, 08001 Prešov, Slovakia; (Ľ.M.); (Ľ.T.)
| | - Ľubomíra Tkáčová
- Department of Nursing, Faculty of Health Care, University of Prešov, Partizánska 1, 08001 Prešov, Slovakia; (Ľ.M.); (Ľ.T.)
| |
Collapse
|
5
|
Fernandez-Carbonell C, Charvet LE, Krupp LB. Enhancing Mood, Cognition, and Quality of Life in Pediatric Multiple Sclerosis. Paediatr Drugs 2021; 23:317-329. [PMID: 33997945 PMCID: PMC8275506 DOI: 10.1007/s40272-021-00451-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/22/2021] [Indexed: 12/12/2022]
Abstract
Pediatric-onset multiple sclerosis (POMS), representing approximately 5% of all MS cases, affects the central nervous system during its ongoing development. POMS is most commonly diagnosed during adolescence but can occur in younger children as well. For pediatric patients with MS, it is critical to manage the full impact of the disease and monitor for any effects on school and social functioning. Disease management includes not only disease-modifying therapies but also strategies to optimize wellbeing. We review the interventions with the highest evidence of ability to improve the disease course and quality of life in POMS. High levels of vitamin D and a diet low in saturated fat are associated with lower relapse rates. Exercise ameliorates fatigue and sleep. Behavioral strategies for sleep hygiene and mood regulation can also improve fatigue and perceived health. POMS management should be addressed holistically, including assessing overall symptom burden as well as the psychological and functional impact of the disease.
Collapse
Affiliation(s)
| | - Leigh E Charvet
- NYU Langone Pediatric Multiple Sclerosis Center, New York, NY, USA
| | - Lauren B Krupp
- NYU Langone Pediatric Multiple Sclerosis Center, New York, NY, USA
| |
Collapse
|
6
|
Digital Technology in Clinical Trials for Multiple Sclerosis: Systematic Review. J Clin Med 2021; 10:jcm10112328. [PMID: 34073464 PMCID: PMC8199078 DOI: 10.3390/jcm10112328] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 05/12/2021] [Accepted: 05/21/2021] [Indexed: 12/17/2022] Open
Abstract
Clinical trials in multiple sclerosis (MS) have been including digital technology tools to overcome limitations in treatment delivery and disease monitoring. In March 2020, we conducted a systematic search on pubmed.gov and clinicaltrials.gov databases (with no restrictions) to identify all relevant published and unpublished clinical trials, in English language, including MS patients, in which digital technology was applied. We used “multiple sclerosis” and “clinical trial” as the main search words, and “app”, “digital”, “electronic”, “internet” and “mobile” as additional search words, separately. Digital technology is part of clinical trial interventions to deliver psychotherapy and motor rehabilitation, with exergames, e-training, and robot-assisted exercises. Digital technology has been used to standardise previously existing outcome measures, with automatic acquisitions, reduced inconsistencies, and improved detection of symptoms (e.g., electronic recording of motor performance). Other clinical trials have been using digital technology for monitoring symptoms that would be otherwise difficult to detect (e.g., fatigue, balance), for measuring treatment adherence and side effects, and for self-assessment purposes. Collection of outcome measures is progressively shifting from paper-based on site, to internet-based on site, and, in the future, to internet-based at home, with the detection of clinical and treatment features that would have remained otherwise invisible. Similarly, remote interventions provide new possibilities of motor and cognitive rehabilitation.
Collapse
|
7
|
Ghai S, Kasilingam E, Lanzillo R, Malenica M, van Pesch V, Burke NC, Carotenuto A, Maguire R. Needs and Experiences of Children and Adolescents with Pediatric Multiple Sclerosis and Their Caregivers: A Systematic Review. CHILDREN (BASEL, SWITZERLAND) 2021; 8:445. [PMID: 34070298 PMCID: PMC8226634 DOI: 10.3390/children8060445] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 05/19/2021] [Accepted: 05/23/2021] [Indexed: 01/21/2023]
Abstract
In the present study we conduct a systematic review to evaluate the needs and experience of people with pediatric multiple sclerosis (MS) and their caregivers. The literature search was conducted across 10 academic databases, adhering to PRISMA-P guidelines. Quality appraisal was conducted using the mixed method appraisal test for individual studies, and GRADE-CERQual to establish overall confidence of findings. Results were analyzed using a process of narrative synthesis. We identified 26 studies which included 2253 children/adolescents with MS (CAMS) and 1608 caregivers. MS was reported to negatively impact experiences for CAMS in domains such as of school performance, social relationships, mental health, and overall physical functioning. Specifically, fatigue and social support were reported as the most important barriers and facilitators for CAMS, respectively. In terms of caregiver experience, negative impacts were reported on social functioning, mental health, and quality of life. Additionally, lack of awareness concerning MS was one of the biggest challenges reported. Caregivers expressed needs for psychological and social support. This study provides the first evidence regarding the needs and experiences of CAMS and their caregivers. Findings can be used to address policy gaps for supporting families affected by pediatric MS.
Collapse
Affiliation(s)
- Shashank Ghai
- School of Physical and Occupational Therapy, McGill University, Montréal, QC H3G 1Y5, Canada
- Feil & Oberfeld Research Centre of the Jewish Rehabilitation Hospital—CISSS Laval, a Research Site of the Centre for Interdisciplinary Research of Greater Montreal (CRIR), Laval, QC H7V 1R2, Canada
- Department of Family Medicine, McGill University, Montréal, QC GRM MDI, Canada
| | | | - Roberta Lanzillo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University, 80138 Naples, Italy; (R.L.); (A.C.)
| | - Masa Malenica
- Department of Child Neurology, Associated Member of the ERN EpiCARE, Sestre Milosrdnice University Hospital Center, 10000 Zagreb, Croatia;
| | - Vincent van Pesch
- Department of Neurology, Cliniques Universitaires Saint-Luc, UCLouvain, 1200 Brussels, Belgium;
| | - Niamh Caitlin Burke
- Department of Psychology, Maynooth University, Maynooth W23 F2K8, Ireland; (N.C.B.); (R.M.)
| | - Antonio Carotenuto
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University, 80138 Naples, Italy; (R.L.); (A.C.)
| | - Rebecca Maguire
- Department of Psychology, Maynooth University, Maynooth W23 F2K8, Ireland; (N.C.B.); (R.M.)
| |
Collapse
|
8
|
Neter E, Wolkowitz A, Glass-Marmor L, Lavi I, Ratzabi S, Leibkovitz I, Miller A. Multiple modality approach to assess adherence to medications across time in Multiple Sclerosis. Mult Scler Relat Disord 2020; 40:101951. [PMID: 32004857 DOI: 10.1016/j.msard.2020.101951] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 11/01/2019] [Accepted: 01/12/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Medication adherence is especially challenging in a chronic condition such as Relapsing Multiple Sclerosis (RMS). Medication adherence among persons with MS (PwMS) is usually assessed via a single measure, mostly electronic pharmacy records. OBJECTIVES Assess medication adherence in multiple modes across time among PwMS; examine consistency across time and associations between measures. METHODS PwMS (N = 194) were surveyed prospectively at three time points (baseline, 6 and 12 months later) and their health records and medication claims were retrospectively obtained. Adherence score was based on medication possession ratio (MPR) and two patient-reported outcome (PRO) measures. Electronic monitoring devices assessing medication adherence were also initiated. RESULTS MPR of each nonadherent PwMS, once compared to medical records containing prescription changes, was found as underestimating adherence. MPR was between the two PROs in identifying nonadherence and associations between the measures and across time was moderate (Kappa ranged 0.37-0.42). The use of electronic monitoring devices was not adopted by patients. A score indicated adherence as 66% and 64.9% at Time1 and Time 2, respectively, with 21.1% of PwMS nonadherent at both time points. Adherence did not vary significantly by DMT type. CONCLUSIONS Being a dynamic behavior, medication adherence should be repeatedly monitored by using multiple modalities and focused on in clinician-patient encounters, especially in chronic diseases such as MS, which requires long-term treatments. Applying PROs in monitoring medication adherence would facilitate implementation of Participatory Medicine and patient-centered strategies in MS care.
Collapse
Affiliation(s)
| | - Anat Wolkowitz
- Rappaport Faculty of Medicine & Research Institute, Technion Institute of Technology, Haifa, Israel
| | - Lea Glass-Marmor
- Rappaport Faculty of Medicine & Research Institute, Technion Institute of Technology, Haifa, Israel
| | - Idit Lavi
- Department of Community Medicine & Epidemiology, Carmel Medical Center, Haifa, Israel
| | - Sharonne Ratzabi
- Rappaport Faculty of Medicine & Research Institute, Technion Institute of Technology, Haifa, Israel
| | - Izabella Leibkovitz
- Rappaport Faculty of Medicine & Research Institute, Technion Institute of Technology, Haifa, Israel
| | - Ariel Miller
- Rappaport Faculty of Medicine & Research Institute, Technion Institute of Technology, Haifa, Israel; Multiple Sclerosis Center & Neuroimmunology Unit, Carmel Medical Center, Haifa, Israel
| |
Collapse
|
9
|
Abstract
PURPOSE OF REVIEW With the recognition that pediatric-onset multiple sclerosis (POMS) is characterized by more prominent disease activity, earlier age at onset of disability milestones, and more prominent cognitive impairment compared with physical disability earlier in the disease course compared with adult-onset multiple sclerosis (AOMS), there has been increasing interest in identifying optimal and safe treatment approaches to achieve better disease control in this group. Injectable therapies have been traditionally used as first line in this population, although not formally approved. This review focuses on current treatment and monitoring approaches in POMS. RECENT FINDINGS In the past few years, and despite the paucity of FDA-approved medications for use in POMS, an increasing trend toward using newer disease-modifying therapies (DMTs) in this group is observed. However, escalation (as opposed to induction) remains the most frequent approach, and many children continue to be untreated before age 18, particularly before age 12. The only FDA- and EMA-approved disease-modifying therapy in POMS is fingolimod; however, dimethyl fumarate, teriflunomide, natalizumab, ocrelizumab, and alemtuzumab either have been evaluated in observational studies or are being currently investigated in formal randomized controlled trials for use in POMS and appear to be safe in this group. Autologous hematopoietic stem cell transplantation has also been evaluated in a small series. Clinical outcome measures and MS biomarkers have been poorly studied in POMS; however, the use of composite functional scores, neurofilament light chain, optical coherence tomography, and imaging findings is being increasingly investigated to improve early diagnosis and efficient monitoring of POMS. Off-label use of newer DMTs in POMS is increasing, and based on retrospective data, and phase 2 trials, this approach appears to be safe in children. Results from ongoing trials will help clarify the safety and efficacy of these therapies in the future. Fingolimod is the only FDA-approved medication for use in POMS. Outcome measures and biomarkers used in AOMS are being studied in POMS and are greatly needed to quantify treatment response in this group.
Collapse
|
10
|
Abstract
Pediatric-onset multiple sclerosis (MS) comprises 2-5% of MS cases, and is known to be associated with high disease activity and the accumulation of disability at an earlier age than their adult-onset counterparts. Appropriate therapy leading to disease control has the potential to alter the known trajectory of adverse long-term physical, cognitive, and psychosocial outcomes in this population. Thus, optimizing treatment for children and adolescents with MS is of paramount importance. The last decade has seen a growing number of disease-modifying therapies approved for relapsing MS in adults, and available agents now include oral, injectable, and infusion therapies. Recently, the development of randomized controlled MS trials in youth has led to the first agent approved by the US FDA for the treatment of pediatric MS-fingolimod. With this, we have entered a new era of knowledge and treatment in this population and ongoing pediatric trials are expected to further inform clinical management. With the emergence of highly effective therapies targeting the inflammatory component of the disease, there has been increased interest in identifying treatment strategies that instead target mechanisms such as remyelination/repair, neuroprotection, or rehabilitation. The potential role for such emerging therapies in the treatment of pediatric MS remains an important area of study. In this review, we discuss current evidence for MS therapies in children including the treatment of acute relapses, disease-modifying therapies, and symptomatic management. We will also discuss evidence for emerging therapies, including remyelinating and neuroprotective agents.
Collapse
Affiliation(s)
- Colin Wilbur
- Department of Pediatrics, Faculty of Medicine and Dentistry, Women and Children's Health Research Institute, University of Alberta, Edmonton, AB, Canada
| | - E Ann Yeh
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada.
- Division of Neurosciences and Mental Health, SickKids Research Institute, Toronto, ON, Canada.
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
| |
Collapse
|
11
|
Rensel M. Long-Term Treatment Strategies of Pediatric Multiple Sclerosis, Including the use of Disease Modifying Therapies. CHILDREN-BASEL 2019; 6:children6060073. [PMID: 31159312 PMCID: PMC6617229 DOI: 10.3390/children6060073] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 05/02/2019] [Accepted: 05/14/2019] [Indexed: 01/20/2023]
Abstract
Multiple sclerosis (MS) presenting in the pediatric years can lead to landmark disability levels younger in life than adult onset MS and so therefore early and effective treatment remains paramount for long-term outcomes. The goals of MS therapeutics in adults have widened to address multiple mechanisms: anti-inflammatory, neuroprotective, and myelin repair, yet the optimal paradigm for MS therapies in the pediatric population is not known. Pediatric onset MS add complexities due to the ongoing development of the central nervous system and the immune system. Clinical trials have led to an increasing number of pharmaceutical therapies for adult onset MS (AOMS), one POMS randomized controlled trial is completed and other trials are ongoing, yet due to the low prevalence of POMS, the dynamic landscape and risk management of the MS disease modifying therapies (DMT) it remains more difficult to complete trials in POMS. There is consensus that controlled clinical trials leading to appropriate and safe therapies for POMS are important for a multitude of reasons that include unique pediatric pharmacokinetics, short and long-term safety, developmental issues, clinical benefits, and regulatory approval. This review will focus on new treatment goals, paradigm, strategies, monitoring, compliance, and products in the long-term treatment of POMS. The discussion will focus on these new concepts and the published data related to DMT use in POMS. This review provides significant insight into new concepts of treatment goals and current approaches to enhance the lives of the POMS patients now and in the future.
Collapse
Affiliation(s)
- Mary Rensel
- The Mellen Center, Department of Neurology, Cleveland Clinic, Cleveland, OH 44195, USA.
| |
Collapse
|
12
|
Yeh EA, Chiang N, Darshan B, Nejati N, Grover SA, Schwartz CE, Slater R, Finlayson M. Adherence in Youth With Multiple Sclerosis: A Qualitative Assessment of Habit Formation, Barriers, and Facilitators. QUALITATIVE HEALTH RESEARCH 2019; 29:645-657. [PMID: 29911511 DOI: 10.1177/1049732318779039] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Rates of medication nonadherence in youth with multiple sclerosis (MS) range from 10% to 60%. Qualitative studies of adherence can provide insight into children's own perspectives about barriers and facilitators to their adherence and inform future interventions. This qualitative longitudinal descriptive study included children with MS ( n = 28) participating in a randomized controlled trial focused on medication adherence ( clinicaltrials.gov : NCT02234713). Following established methods, three independent reviewers coded transcripts of motivational interviewing (MI) sessions (three interviews per subject, performed monthly over a 3-month period) for relevant themes. They were subsequently categorized using inductive content analysis. Youth described medication adherence as being dependent on the ability to build and maintain healthy habits related to medication use, including embodiment of these habits. Barriers and facilitators included remembering/forgetting, experiences with fatigue, and experiences with medication. These themes were maintained through the second and third interviews. Future research focus on barriers and facilitators to habit maintenance in this population.
Collapse
Affiliation(s)
- E Ann Yeh
- 1 The Hospital for Sick Children, Toronto, Ontario, Canada
- 2 The University of Toronto, Toronto, Ontario, Canada
| | - Nicole Chiang
- 3 School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
| | - Bindia Darshan
- 3 School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
| | - Nadine Nejati
- 1 The Hospital for Sick Children, Toronto, Ontario, Canada
- 2 The University of Toronto, Toronto, Ontario, Canada
| | | | - Carolyn E Schwartz
- 4 DeltaQuest Foundation, Concord, Massachusetts, USA
- 5 Tufts University, Boston, Massachusetts, USA
| | - Ruth Slater
- 1 The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Marcia Finlayson
- 3 School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
| |
Collapse
|
13
|
Ghezzi A, Bianchi A, Baroncini D, Bertolotto A, Malucchi S, Bresciamorra V, Lanzillo R, Milani N, Martinelli V, Patti F, Chisari C, Rottoli M, Simone M, Paolicelli D, Visconti A. A multicenter, observational, prospective study of self- and parent-reported quality of life in adolescent multiple sclerosis patients self-administering interferon-β1a using RebiSmart™-the FUTURE study. Neurol Sci 2017; 38:1999-2005. [PMID: 28831635 DOI: 10.1007/s10072-017-3091-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 08/07/2017] [Indexed: 11/28/2022]
Abstract
Besides the impact of disease per se, the use of immunomodulatory therapies in adolescents with relapsing-remitting multiple sclerosis (RRMS) may have an effect on quality of life (QL). The FUTURE (Quality of liFe in adolescent sUbjecTs affected by mUltiple sclerosis treated with immunomodulatoRy agEnt using self-injecting device) study was designed to evaluate the changes in QL of Italian adolescents with RRMS receiving treatment with IFN-β1a (Rebif; 22 μg), administered subcutaneously three times weekly using the RebiSmart™ electronic autoinjection device over a 52-week period. Fifty adolescents with RRMS were enrolled and 40 completed the study. Changes from baseline to end of treatment (EoT) in adolescent self-reported and parent-reported QL were assessed using the Pediatric Quality of Life Inventory Multidimensional Fatigue Scale (PedsQL), which has been validated for use in pediatric MS and for which an Italian version is available. The adolescent self-reported total PedsQL4.0 score and all of its subscales tended to increase from baseline to EoT, the only exception being "Emotional functioning." In parent-reported measures, the total PedsQL4.0 score increased significantly from baseline to EoT (+ 5.27 points, p = 0.041). Significant increases were also evident for parent-reported "Psychosocial health summary score" (+ 5.90 points; p = 0.015) and "School functioning" (+ 7.84 points; p = 0.029). Our results indicate that adolescents with RRMS using the electronic injection device RebiSmart™ for self-administration of Rebif® can experience long-term improvements in QL.
Collapse
Affiliation(s)
- A Ghezzi
- Azienda Ospedaliera S. Antonio Abate, Gallarate, Italy.
| | - A Bianchi
- Azienda Ospedaliera S. Antonio Abate, Gallarate, Italy
| | - D Baroncini
- Azienda Ospedaliera S. Antonio Abate, Gallarate, Italy
| | - A Bertolotto
- AOU S. Luigi Gonzaga Neurologia 2 CRESM, Orbassano, Italy
| | - S Malucchi
- AOU S. Luigi Gonzaga Neurologia 2 CRESM, Orbassano, Italy
| | - V Bresciamorra
- Azienda Ospedaliero Universitaria Policlinico Federico II, Naples, Italy
| | - R Lanzillo
- Azienda Ospedaliero Universitaria Policlinico Federico II, Naples, Italy
| | - N Milani
- Istituto Neurologico Carlo Besta, Milan, Italy
| | | | - F Patti
- Department of Medical and Surgical Sciences, and Advanced Technologies, Neuroscience Section, Multiple Sclerosis Center, University of Catania, Catania, Italy
| | - C Chisari
- Department of Medical and Surgical Sciences, and Advanced Technologies, Neuroscience Section, Multiple Sclerosis Center, University of Catania, Catania, Italy
| | - M Rottoli
- Neurologia USS Malattie Autoimmuni - Centro Sclerosi Multipla ASST Papa Giovanni XXIII, Bergamo, Italy
| | - M Simone
- Dip di Scienze mediche di Base, Neuroscienze ed Organi di Senso Università di Bari, Bari, Italy
| | - D Paolicelli
- Dip di Scienze mediche di Base, Neuroscienze ed Organi di Senso Università di Bari, Bari, Italy
| | - A Visconti
- Medical Affair Department Merck Serono, Rome, Italy
| | | |
Collapse
|