The use of interferon beta in relapsing-remitting multiple sclerosis

Abstract

The use of interferon beta-1a to treat multiple sclerosis in a child of 7 years of age is discussed. To date, there is only one other published report of the use of interferon beta in a child as young as this. One year after commencing treatment she had shown significant clinical improvement, with a marked reduction in number of relapses. In her second year of treatment she suffered a major relapse from which she slowly recovered.M ultiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system with a clinical onset usually occurring between the ages of 20 and 40. Onset below the age of 10 is rare, reported in less than 1% of cases.1 The majority of children with MS exhibit a relapsing-remitting course and the frequency of relapses is thought to correlate with eventual disability. 1There has been much interest in the role of interferon beta to reduce disease activity in adults with MS over the past decade, with trials showing clinical and magnetic resonance imaging (MRI) improvement, reduction in relapse frequency and severity, and improvement in disability scores.2-4 A systematic review of its role in relapsing-remitting MS showed that the number of patients who experienced exacerbations was reduced by about 25% during the first year of treatment. However, over a longer period results were inconclusive, largely due to insufficient data. 5There is far less published data available on the use of interferon beta in children. One case is reported from North America of the use of interferon beta in a child aged 7 years. This child commenced treatment with interferon beta-1b four years after a diagnosis of relapsing-remitting MS was made. There was marked clinical improvement during the first year of treatment but he subsequently developed neutralising antibodies, corresponding with new lesions on cranial MRI but little clinical change. After three years of treatment, the authors report there have been no side effects and no significant relapses. 6 CASE REPORTA 4K year old girl presented with a 24 hour history of nonspecific headaches, slurred speech, and left sided weakness of the arm and face. Cranial computed tomography (CT) showed 4-5 multifocal enhancing mass lesions. She had a mild neutrophilia but examination of the cerebrospinal fluid (CSF) was normal. All samples sent for serology proved negative. A diagnosis of para-infectious encephalitis was made and she was treated for 10 days of intravenous antibiotics and acyclovir. Five days of dexamethasone was given with resultant clinical and CT improvement.She was readmitted two weeks later with pain and weakness in her right leg and arm and a prolonged right sided motor seizure. T2 weighted MRI at this time showed abnormal signal in the white matter in both fronto-parietal regions, extending to the Sylvian fissure, with some cystic necrosis on the left (fig 1). T1 weighted images following contrast showed new ring-like enhancements of the right frontal lobe and thalamus. MRI spine was normal. A brain biopsy was performed which showed a nec...

Multiple Sclerosis in Children

“…Safety and tolerability of IFNb and GA have been explored in several retrospective reviews. 29,[76][77][78][79][80][81][82][83]…”

Subcutaneous Interferon Beta-1a in Pediatric Multiple Sclerosis

“…Small cohort studies and isolated case reports indicate that interferon-b therapies are well tolerated and appear to be effective in the treatment of pediatric multiple sclerosis. [19][20][21][22][23][24][25][26][27][28] To capture more comprehensive experience with subcutaneous interferon b-1a in a large, multinational pediatric multiple sclerosis population, this study reviewed the safety and tolerability of subcutaneous interferon b-1a in children and adolescents with demyelinating events, based on retrospective data from medical records. Although the study was not designed to evaluate efficacy, additional data were collected to explore the impact of treatment on clinical relapses.…”

Subcutaneous interferon β-1a in pediatric patients with multiple sclerosis: Regional differences in clinical features, disease management, and treatment outcomes in an international retrospective study

“…Still, it remains unclear how pediatric patients with MS respond to DMTs and whether regional differences impact the management of MS with DMTs. Small studies (most involving 50 or fewer participants) have demonstrated that baseline relapse rates decrease after treatment with DMTs [4][5][6][7][8][9][10][11][12]. Recently, our group, the REPLAY study investigators, completed the largest reported retrospective analysis of treatment experience with subcutaneous (sc) interferon (IFN) β-1a in pediatric patients with MS. Based on the review of medical records from 307 pediatric patients (298 of whom had a final diagnosis of MS) enrolled from eight countries, we found that adult doses of sc IFN β-1a (44 and 22 μg three times weekly [tiw]) were well tolerated and associated with a reduction in relapse rates compared with rates before treatment [12].…”