Treatment Of Breakthrough Disease

There is consensus that therapy in relapsing-remitting multiple sclerosis (MS) in the pediatric age group should be initiated with first-line treatments approved for adult multiple sclerosis (MS), namely one of the three forms of interferon-beta or glatiramer acetate (GA). However, as in adults with multiple sclerosis (MS), the disease remains clinically or radiologically active in some children despite first-line therapies even 6-12 months after initiation of an appropriate regimen. In adult breakthrough disease, treatment strategies include switching to another first-line agent, adding another agent to the on-going therapy (combination therapy), or switching to a second-line drug such as natalizumab or immunosuppression. Although very few data are available regarding tolerability and efficacy of these therapeutic strategies in pediatric multiple sclerosis (MS), there is anecdotal evidence from several pediatric multiple sclerosis centers that a variety of treatments are being used for the treatment of breakthrough disease in this age group. Most of the drugs considered are either approved for the treatment of multiple sclerosis in the adult age group (natalizumab, mitoxantrone) or approved for other indications than Read more [...]

Treatment Of Breakthrough Disease: Combination Therapies

Combination therapy of either first-line drugs (interferon beta and glatiramer acetate) or first-line drugs with a second-line agent is sometimes used as an approach to obtain better disease control in breakthrough multiple sclerosis (MS). Similar treatment strategies combining drugs with different mechanisms of action have provided utility in other autoimmune diseases, such as rheumatoid arthritis where early, aggressive combination therapy is considered the best treatment paradigm for ensuring adequate disease control and optimizing long-term outcome. The goal of combination therapy should be to improve disease control without aggravating adverse events. Very few studies have appropriately looked at the effect of combining therapies in adult multiple sclerosis patients with breakthrough disease on first-line agents, and none in children. Interferon beta and glatiramer acetate An obvious combination treatment would be glatiramer acetate and interferon beta. The two first-line treatments have quite different mechanisms of action and thus could, in theory, have additive or synergistic effects. However, studies on the mechanism of action of glatiramer acetate and interferon beta have indicated that a combination of both Read more [...]

Side Effects of Mood Stabilizers and Atypical Antipsychotics

This post provides an overview of developmental issues related to side effects, and then reviews the most common adverse events and concerns related to mood stabilizers and atypical antipsychotics. There are clear developmental differences in adverse event expression or side effects risks when mood stabilizers and antipsychotics are used in children and adolescents. All the mood stabilizers and antipsychotic medications produce adverse events. Each mood stabilizer and each atypical antipsychotic medication has its own adverse events profile. Prescribing physicians need to be familiar with the spectrum of risks for each of these medications. Currently, concerns with cardiovascular and metabolic complications take center stage in current mood stabilizing and antipsychotic treatments. Children and adolescents are more vulnerable to these risks. Sudden-death risk with the use of atypical antipsychotics is due to cardiovascular and metabolic risks, or the result of pancreatitis or liver failure. Females have an increased risk for these complications. Polypharmacy increases the risk of side effects. Increase in pediatric psychotropic polypharmacy is on the rise. Caution must be exercised when initiating these practices. Read more [...]