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ObjectiveThis study aimed to review the efficacy and safety profile of disease-modifying therapies (DMTs) in patients with relapsing pediatric-onset multiple sclerosis (POMS).MethodsA systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Published randomized controlled trials (RCTs), nonrandomized studies with a control group, large single-arm studies, and ongoing (unpublished) studies investigating the use of approved and unapproved DMTs in POMS were included. Eligible published studies were identified in MEDLINE (via PubMed), EMBASE, and the Cochrane Library, and unpublished studies were identified in a clinical trials registry (www.Clinicaltrialsgov).ResultsA total of 13 published studies were included in the systematic review: 4 RCTs, 3 observational studies with a control group, and 6 large single-arm studies. The following DMTs for the treatment of POMS were evaluated in the included studies: interferon beta-1a, interferon beta-1b, teriflunomide, dimethyl fumarate, fingolimod, natalizumab, glatiramer acetate, and ocrelizumab. All DMTs were shown to be effective in reducing relapse rates, preventing disability progression, and reducing disease activity in MRI in patients with POMS. DMTs that are considered highly effective in adults with multiple sclerosis (natalizumab, fingolimod) were also shown to be more effective than interferon beta-1a in POMS. A total of 9 ongoing (unpublished) studies were identified, including 5 RCTs. The following drugs were evaluated: ozanimod, fingolimod, peginterferon beta-1a, ocrelizumab, ofatumumab, siponimod, alemtuzumab, and natalizumab.ConclusionThe number of DMTs approved for the treatment of POMS is limited, and some of the available DMTs are used off-label. The available evidence from published studies of varying reliability supports the efficacy of DMTs in POMS. However, well-designed, long-term RCTs in the pediatric population are needed. The results of ongoing studies may fill the existing gap in clinical evidence, possibly leading to the approval of more highly effective DMTs for patients with POMS.

Abstract licence: CC BY-NC-ND

Abstract Background To systematically assess the impact of disease-modifying therapy (DMT) on the risk of uveitis in patients with multiple sclerosis (MS) and to investigate potential variations among different DMT types, MS types, and clinical characteristics. Methods A systematic search was conducted across PubMed, Embase, Cochrane Library, CNKI, Wanfang, and VIP databases from the self-established database up to September 2025. This search aimed to identify randomized controlled trials, cohort studies, and observational studies that reported the incidence of uveitis following disease-modifying therapy (DMT) in patients with multiple sclerosis (MS). Meta-analysis was performed using Stata 18.0. Bivariate outcomes were expressed as odds ratios (OR) with 95% confidence intervals (CI). Heterogeneity was evaluated using the I² test, applying a random effects model when I² was ≥ 50%. Publication bias was assessed through funnel plots and the Egger test, while sensitivity analysis was conducted using the leave-one-out method to confirm the stability of the results. Results A total of 8 studies (1 RCT, 7 observational studies) involving patients with multiple sclerosis (MS) from various regions were included. The pooled analysis indicated that disease-modifying therapy (DMT) significantly reduced the prevalence of uveitis (SMD = -0.42, 95% CI: -0.83 to -0.01, P  = 0.04). In the one-arm rate analysis, the combined prevalence was approximately 1% (95% CI: 0.00–0.01, I² = 88.09%). Subgroup analysis revealed that interferon beta and glatiramer acetate were associated with the highest risk of uveitis (~ 0.32), while fingolimod and rituximab were linked to the lowest risk (~ 0.01), with significant differences observed between groups ( P  

Abstract licence: CC BY

Multiple sclerosis (MS) is a chronic autoimmune disorder of the central nervous system (CNS) and the leading cause of non-traumatic neurological disability in young adults. Although current disease-modifying therapies (DMTs), such as interferon beta (IFNβ) and glatiramer acetate, can reduce inflammation and delay disease progression, many patients continue to experience relapses. Given the complexity and variability of MS, combination therapy targeting multiple disease mechanisms is being explored as a more effective treatment approach. A comprehensive search of Medline and EMBASE databases was conducted using keywords related to MS, immunomodulatory agents, and combination therapy. Additional clinical trials were identified through the National MS Society database. A limited number of studies have investigated the use of IFNβ with or without immunosuppressive agents. Preliminary findings suggest potential benefits of combination therapy, though evidence is constrained by small sample sizes, lack of randomization, and limited follow-up periods. Combination therapies may offer enhanced therapeutic effects in MS management. However, more rigorous and large-scale clinical trials are required to confirm their safety and efficacy.

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