Early Predictors of 9-Year Disability in Pediatric Multiple Sclerosis

Ermelinda De Meo, Raffaello Bonacchi, Lucia Moiola, Bruno Colombo, Francesca Sangalli, Chiara Zanetta, Maria Pia Amato, Vittorio Martinelli, Maria Assunta Rocca and Massimo Filippi

ANN NEUROL 2021;89:1011–102

Selezionato dal Lettore: Dr. Angelo Bellinvia – Università degli studi di Firenze,  Dipartimento NEUROFARBA

MOTIVATION: Pediatric onset Multiple Sclerosis (POMS) patients represent 3 to 10% of the total MS population. However, a few longitudinal studies have explored the predictors of long-term disability in POMS patients.
In this interesting study, 123 pediatric MS patients were assessed at year 1,2 and after 9 years. Different clinical and imaging predictors of time to first relapse, annualized relapse rate, 9-years disability worsening and EDSS score were found. As for time to first relapse, optic nerve lesions were the stronger predictor (HR =2.1, p= 0.002), while lower annualized relapse rate was interestingly predicted by high-efficacy treatment exposure in all the models, also when considering year 1 and year 2 variables (Beta= - 0.14, p = 0.01). Nine-years disability worsening was predicted by early disability worsening (at one year the OR was 26.05, p < 0.001). Finally, the 9-year EDSS score was most strongly predicted by early EDSS changes (Beta= 0.79, p < 0.001). In conclusion, this study underscores the role of an accurate early clinical and MRI monitoring in predicting disability worsening among POMS patients.