ArticleMultiple sclerosis (Houndmills, Basingstoke, England)2026
Treatment persistence in paediatric-onset multiple sclerosis: A Swedish nationwide registry study.
Article in Multiple sclerosis (Houndmills, Basingstoke, England), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundComparative studies in paediatric-onset multiple sclerosis (PoMS) that also include highly effective monoclonal antibody therapies are rare.
objectiveTo compare treatment persistence, as a proxy of effectiveness and tolerability, across disease-modifying therapies (DMTs).
methodsNationwide cohort study using Swedish MS Registry data on individuals with MS onset before age 18 from 2000 to 2024. Treatment persistence was analysed using Kaplan-Meier and Cox models, adjusted for demographics and treatment epoch.
resultsWe included 383 individuals (69.2% female; median onset age 15.8 and 17.2 years at first DMT start), observed for a median 10.1 years (interquartile range (IQR): 5.5-15.5), yielding 934 treatment episodes: rituximab (272), injectables (263), natalizumab (248), fingolimod (86) and dimethyl fumarate (65). Median age at any treatment initiation, regardless of treatment sequence, was 18.9 years, with a median Expanded Disability Status Scale (EDSS) score of 1.5 (IQR: 0.0-2.0). Treatment persistence never dropped below 50% for rituximab, while median persistence was 35.6 months for natalizumab (95% confidence interval (CI): 28.8-44.9), 34.7 for dimethyl fumarate (95% CI: 21.7-56.9), 32.0 for fingolimod (95% CI: 21.1-48.1) and 17.6 for injectables (95% CI: 14.4-20.8). Compared to injectables, adjusted hazard ratios (HRs) for discontinuation were significantly lower for rituximab (0.09; 95% CI: 0.07-0.12), natalizumab (0.39; 95% CI: 0.31-0.48), fingolimod (0.41; 95% CI: 0.30-0.55) and dimethyl fumarate (0.49; 95% CI: 0.36-0.68).
conclusionRituximab displayed the highest treatment persistence, supporting B-cell depletion as a first-line option in PoMS.
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