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O'Donnell E, Schuette A, Waltz M, Aaen G, Benson L, Gorman M, Lotze T, Mar S, Ness J, Rodriguez M, Tillema JM, Schreiner T, Wheeler Y, Casper TC, Chitnis T. Patient and family views on research priorities and design of clinical trials and research studies in pediatric multiple sclerosis. Mult Scler 2024:13524585241274580. [PMID: 39286941 DOI: 10.1177/13524585241274580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2024]
Abstract
BACKGROUND AND OBJECTIVES This survey study aimed to (1) identify patient/family research priorities in pediatric-onset multiple sclerosis (POMS), and (2) delineate optimized methods for research study/clinical trials design, engagement, and implementation. METHODS Participants were as follows: (1) parents of a child (<18 years) with POMS enrolled in a national registry, (2) adolescents (13-17 years) with POMS in the registry, and (3) adults (18-40 years) with POMS receiving care at a registry affiliated clinic. Of 293 eligible participants, 192 completed surveys. RESULTS Experiences with health care and medications were generally positive but there remain areas of priority improvement. Incentives to participate in clinical trials included medications previously tested and in pill form, bloodwork/study visits required ⩾ every 3 months, cognitive testing ⩽1 hour, compensation for travel and time, ability to continue current multiple sclerosis (MS) medication, option to take study medication if on placebo, and individualized study feedback. Priorities for clinical research were (1) psychosocial impact, (2) cognitive/academic impact, (3) environmental risk, and (4) nutrition. CONCLUSIONS Results highlighted the importance of a holistic approach to study design and a focus on the impact of disease on daily life to best engage patients and families in POMS clinical trials and research.
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Affiliation(s)
- Ellen O'Donnell
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | | | | | - Gregory Aaen
- Loma Linda University Children's Hospital, Loma Linda, CA, USA
| | | | | | | | - Soe Mar
- St. Louis Children's Hospital, St. Louis, MO, USA
| | - Jayne Ness
- Children's Hospital of Alabama, Birmingham, AL, USA
| | | | | | | | | | | | - Tanuja Chitnis
- Division of Child Neurology, Massachusetts General Hospital, Boston, MA, USA
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Wilson E, Howard D, Daniel D, Taylor L, Gorman MP, Benson LA. Disease modifying treatment for pediatric onset multiple sclerosis: Ethical considerations and strategies to navigate parental refusal. Mult Scler Relat Disord 2023; 79:104970. [PMID: 37690437 DOI: 10.1016/j.msard.2023.104970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 07/28/2023] [Accepted: 08/28/2023] [Indexed: 09/12/2023]
Affiliation(s)
- Elizabeth Wilson
- Boston Children's Hospital, Department of Neurology 300 Longwood Avenue, Boston, MA 02115, United States; Massachusetts General Brigham Hospital, Department of Neurology 55 Fruit Street, Boston, MA 02114, United States.
| | - Danielle Howard
- Massachusetts General Brigham Hospital, Department of Neurology 55 Fruit Street, Boston, MA 02114, United States
| | - Dennis Daniel
- Boston Children's Hospital, Critical care medicine 300 Longwood Avenue, Boston, MA 02115, United States
| | - Lisa Taylor
- Boston Children's Hospital, Office of Ethics 300 Longwood Avenue, Boston, MA 02115, United States
| | - Mark P Gorman
- Boston Children's Hospital, Department of Neurology 300 Longwood Avenue, Boston, MA 02115, United States
| | - Leslie A Benson
- Boston Children's Hospital, Department of Neurology 300 Longwood Avenue, Boston, MA 02115, United States
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Prajjwal P, M.D.M. M, Natarajan B, Inban P, Gadam S, Sowndarya D, John J, Abbas R, Vaja H, A.D.M. M, Amir Hussin O. Juvenile multiple sclerosis: addressing epidemiology, diagnosis, therapeutic, and prognostic updates along with cognitive dysfunction and quality of life. Ann Med Surg (Lond) 2023; 85:4433-4441. [PMID: 37663711 PMCID: PMC10473341 DOI: 10.1097/ms9.0000000000000930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 05/19/2023] [Indexed: 09/05/2023] Open
Abstract
Juvenile multiple sclerosis (JMS) is a rare but significant subtype of multiple sclerosis (MS) that affects a small percentage of patients under the age of 10 and 3-5% of all MS patients. Despite its rarity, JMS poses unique challenges in terms of diagnosis, treatment, and management, as it can significantly impact a child or adolescent's physical, cognitive, and emotional development. JMS presents with a varying spectrum of signs and symptoms such as coordination difficulties and permanent cognitive dysfunctions and may include atypical clinical features such as seizures, acute disseminated encephalomyelitis, and optic neuritis, making diagnostic evaluations challenging. Whilst the biology of JMS shares similarities with adult-onset MS, there exist notable distinctions in disease progression, clinical manifestations, and ultimate prognoses. The International Pediatric MS Study Group (IPMSSG) was founded in 2005 to improve understanding of JMS, but there remains a lack of knowledge and guidelines on the management of this condition. This review summarizes the current knowledge on JMS, including its epidemiology, clinical presentations, diagnostic challenges, current treatment options, and outcomes. Current treatment options for JMS include disease-modifying therapies, but JMS can also result in impaired quality of life and psychiatric comorbidity, highlighting the need for comprehensive care for affected children. Through gathering and analyzing scattered studies and recent updates on JMS, the authors aim to address the gaps in current knowledge on JMS and provide an improved understanding of appropriate care for affected children. By doing so, this review hopes to contribute to improving the quality of life and outcomes for JMS patients.
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Affiliation(s)
| | - Marsool M.D.M.
- University of Baghdad, Al-Kindy College of Medicine, Baghdad, Iraq
| | - Balaganesh Natarajan
- St. George’s University School of Medicine, University Centre Grenada, West Indies
| | - Pugazhendi Inban
- Internal Medicine, Government Medical College, Omandurar, Chennai
| | - Srikanth Gadam
- Internal Medicine, Postdoctoral Research Fellow, Mayo Clinic, USA
| | | | - Jobby John
- Somervell Memorial CSI Medical College and Hospital, Karakonam, Trivandrum
| | - Rahim Abbas
- Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
| | - HariOm Vaja
- Internal Medicine, BJ Medical College, Ahmedabad, India
| | - Marsool A.D.M.
- University of Baghdad, Al-Kindy College of Medicine, Baghdad, Iraq
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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.
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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
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YÜKSEL YILMAZ D, YARDIMCI F. Retrospective Evaluation of Demographic and Clinical Characteristics of Children with Multiple Sclerosis. KOCAELI ÜNIVERSITESI SAĞLIK BILIMLERI DERGISI 2022. [DOI: 10.30934/kusbed.1060124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objective: This retrospective study was conducted to present the clinical features and treatment experiences of child and adolescent patients diagnosed with multiple sclerosis (MS).
Methods: Demographic data, current complaints and clinical findings of patients in addition to treatment modalities applied and compliance of pediatric patients with MS to treatments were evaluated retrospectively in the context of a data collection form.
Results: The data of 40 patients were analyzed in this retrospective study. Of our patients 77.5% were female and the mean age of participants was 16 and the mean of age when patients experienced the first attack was 13.9% approximately half of our patients were receiving interferon beta 1a subcutaneously and 27.5% were receiving glatiramer acetate and their mean duration of use was 18 months. The ratio of patients who did not receive any treatment was 20%. Of the patients receiving treatment, 31.2% experienced side effects due to the drug and 15.6% could not comply with the treatment because of side effects of treatment. The treatment of all patients who failed to comply with the current treatment was changed. In our study, there was a family history of MS in 3 cases. Of patients, 72.5% received intravenous methylprednisolone treatment for between 3 and 10 days during the the first episodes of their illness, and more than half (79.2%) of the patients got completely or nearly completely better. Of patients, 80% had relapsing-remitting MS and 20% had clinical / radiological isolated syndrome.
Conclusion: Childhood MS is seen more commonly in girls and the most frequently in the relapsing-remitting form. Interferon beta 1a and glatiramer acetate are mostly used in the treatment of childhood MS. With immunomodulatory treatment, a decrease both in the number of attacks and in the average expanded disability status scale score, besides an improvement for health can be provided.
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Zaffaroni M. Fingolimod in pediatric-onset multiple sclerosis. Neurol Sci 2021; 42:1-4. [PMID: 33945033 DOI: 10.1007/s10072-021-05294-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 04/28/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Mauro Zaffaroni
- Multiple Sclerosis Centre, Hospital of Gallarate, ASST della Valle Olona, Via Pastori 4, 21013, Gallarate, Italy.
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Fingolimod in pediatric multiple sclerosis: three case reports. Neurol Sci 2021; 42:19-23. [PMID: 33483884 DOI: 10.1007/s10072-021-05076-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 01/18/2021] [Indexed: 12/22/2022]
Abstract
Treatment for pediatric-onset multiple sclerosis (POMS) currently reflects treatment for adult-onset MS, despite some differences in its clinical course. First-choice treatment of POMS generally consists of interferon β-1a or glatiramer acetate, with therapies such as natalizumab or fingolimod reserved for second-choice treatment. In cases of severe disease, both fingolimod and natalizumab can be considered first-choice therapy. This paper presents three case histories of patients with POMS and highlights the different uses of fingolimod within the POMS treatment algorithm. The first and third cases are examples of escalation therapy, both in females aged 16 to 17 years, with fingolimod administering as second choice following disease progression. The second case is an example of using fingolimod as first-choice therapy, given to a 12-year-old male with severe disease. In all three cases, over a period of approximately 1 year after the initiation of fingolimod treatment, there was no further disease progression and no adverse events were recorded.
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Jure Hunt D, Traboulsee A. Short-term outcomes of pediatric multiple sclerosis patients treated with alemtuzumab at a Canadian University multiple sclerosis clinic. Mult Scler J Exp Transl Clin 2020; 6:2055217320926613. [PMID: 32655877 PMCID: PMC7333501 DOI: 10.1177/2055217320926613] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 04/04/2020] [Indexed: 11/15/2022] Open
Abstract
There is a lack of literature documenting the use of alemtuzumab in pediatric multiple sclerosis (MS) patients. Here we describe a 16-year-old and a 17-year-old patient receiving alemtuzumab and being followed for 37 months and 20 months, respectively. Both patients experienced a 1.0 decrease in Expanded Disability Status Scale since initial alemtuzumab infusion and had stable disease. No serious infusion reactions, infections, or definite relapses were recorded on follow-up. Alemtuzumab has been relatively well-tolerated and effective; however, larger, longer-term studies are necessary to understand the specific risks and benefits of alemtuzumab in pediatric MS.
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Affiliation(s)
| | - Anthony Traboulsee
- Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, Canada
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Ziemssen T, Kern R, Voigt I, Haase R. Data Collection in Multiple Sclerosis: The MSDS Approach. Front Neurol 2020; 11:445. [PMID: 32612566 PMCID: PMC7308591 DOI: 10.3389/fneur.2020.00445] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 04/27/2020] [Indexed: 01/17/2023] Open
Abstract
Multiple sclerosis (MS) is a frequent chronic inflammatory disease of the central nervous system that affects patients over decades. As the monitoring and treatment of MS become more personalized and complex, the individual assessment and collection of different parameters ranging from clinical assessments via laboratory and imaging data to patient-reported data become increasingly important for innovative patient management in MS. These aspects predestine electronic data processing for use in MS documentation. Such technologies enable the rapid exchange of health information between patients, practitioners, and caregivers, regardless of time and location. In this perspective paper, we present our digital strategy from Dresden, where we are developing the Multiple Sclerosis Documentation System (MSDS) into an eHealth platform that can be used for multiple purposes. Various use cases are presented that implement this software platform and offer an important perspective for the innovative digital patient management in the future. A holistic patient management of the MS, electronically supported by clinical pathways, will have an important impact on other areas of patient care, such as neurorehabilitation.
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Affiliation(s)
- Tjalf Ziemssen
- Center of Clinical Neuroscience, University Hospital Carl Gustav Carus, Dresden, Germany
| | | | - Isabel Voigt
- Center of Clinical Neuroscience, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Rocco Haase
- Center of Clinical Neuroscience, University Hospital Carl Gustav Carus, Dresden, Germany
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