Table 1.
Summary of injectable disease modifying therapy for pediatric-onset multiple sclerosis (POMS).
| Interferon Β 1a | |
| Mechanism of Action | Shifts cytokine balance to a more anti-inflammatory profile; reduces trafficking of inflammatory cells across the blood brain barrier |
| Dosing | Dose titration to start 22 or 44 µg sq three times weekly; 30 µg im weekly; or 125 µg sq every other week |
| Side effect | injection-site erythema, influenza-like illness, pyrexia, headache, myalgia, chills, injection-site pain, injection-site pruritus, arthralgia and asthenia |
| Monitoring | CBC and LFT at baseline and q 6 months |
| Pregnancy test prior to use, it is not recommended to get pregnant or nurse while on this product | |
| Adverse events | depression |
| elevated transaminases and thyroid abnormalities | |
| Neutralizing antibodies to interferons | |
| POMS publications | [21] |
| POMS RCT | Ongoing, ClinicalTrials.gov Identifier: NCT03870763 |
| Interferon β-1b | |
| Mechanism of Action | Shifts cytokine balance to a more anti-inflammatory profile; reduces trafficking of inflammatory cells across the blood brain barrier |
| Dosing | 0.25mg sq every other day |
| Side effects | See Interferon β-1a |
| Monitoring | |
| Adverse events | |
| POMS publications | [22] |
| POMS RCT | none |
| Glatiramer Acetate | |
| Mechanism of action | Modulates function of antigen-presenting cells; induces differentiation of CD4 + T cells into Th2 cells |
| Dosing | 20 mg sq every day or 40 mg sq three times a week |
| Side effects | injection-site reactions, chest pain, rash, dyspnea, and vasodilation |
| Monitoring | No blood work required |
| Adverse events | Lipoatrophy, skin necrosis |
| POMS publications | [23] |
| POMS RCT | none |
| Daclizumab | |
| Mechanism of action | Humanized monoclonal antibody to alpha subunit of IL-2 receptor, reducing IL–2-mediated activation of lymphocytes |
| Dosing | 150 mg sq once monthly |
| Side effects | influenza, bronchitis, eczema, lymphadenopathy, nasopharyngitis, upper respiratory tract infection, rash, and dermatitis. Rash (7% to 11%), depression (7% to 10%), upper respiratory tract infection (9% to 17%), pharyngitis (25%), and elevated ALT levels (5% to 6%) http://www.accessdata.fda.gov/drugsatfda_docs/label/2016/761029s000lbl.pdf |
| Monitoring | Assess for Hepatitis B and C, Daclizumab is contraindicated in Hepatitis B and C |
| Assess for LFT at baseline, preexisting hepatic disease or impairment (ALT or aspartate transaminase ≥2 times the upper limit) or history of autoimmune hepatitis is contraindicated | |
| Pregnancy test prior to use, it is not recommended to get pregnant or nurse while on this product | |
| Adverse events | Autoimmune Encephalitis (removed from US market 2018) |
| Colitis | |
| Elevated Liver enzymes | |
| POMS publication | [24] |
| POMS RCT | none |
Abbreviations: sq = subcutaneous, im = intramuscular, CBC = complete blood count, LFT = liver function test.