LAUSR

The approach to treatment of relapsing-remitting multiple sclerosis (RRMS) is rapidly evolving, with more than 15 disease-modifying therapies (DMTs) currently licensed for adults. Current treatment algorithms in children with multiple sclerosis (MS) remain heavily reliant on adult MS protocols, and most DMTs in children are prescribed off-label. Convincing evidence has increasingly emerged to support the biological rationale that effective DMTs in adult patients with MS are equally efficacious in children. 1 To date, only 2 randomized clinical trials of DMTs have been published in pediatric-onset MS (POMS). 2,3 This is partly a result of major recruitment challenges due to the low incidence and prevalence of POMS, in addition to challenges of MS diagnosis in children, with an emphasis on exclusion of other mimics, particularly antibody-mediated diseases such as myelin oligodendrocyte glycoprotein and aquaporin-4 antibodies. 4 Both previously published clinical trials in POMS compared newer oral agents (teriflunomide and fingolimod) to either older injectables or placebo. In the TERIKIDS trial, conducted at 57 clinical centers in 22 countries, 109 patients (aged <18 years) were randomly assigned to teriflunomide and 57 to placebo. The study demonstrated similar efficacy of teriflunomide in a pediatric cohort compared with previous adult data, with a reduction in the adjusted number of new or enlarging T2 lesions per magnetic resonance imaging (MRI) scan by 55% and the hazard of relapse by 34% over 2 years. The PARADIGMS trial, meanwhile, enrolled 215 patients (aged <18 years) across 80 centers worldwide, with 107 patients assigned to fingolimod, and 108 to interferon β-1a. This study demonstrated superiority of fingolimod with a lower rate of relapse (0.12 vs 0.67, P < .001), lower accumulation of lesions on MRI (4.39