Rituximab Use in Aggressive Pediatric Multiple Sclerosis: A Case Report

Abstract

Pediatric-onset Multiple Sclerosis (POMS) is a chronic inflammatory demyelinating disorder affecting the central nervous system in children. It can lead to debilitating motor and cognitive sequelae. Disease modifying therapies have been used in children as well as adults, with similarities observed in terms of tolerance, and side-effect profiles. At present the consensus in management of Pediatric MS is based mainly upon adult-based treatment trials. Multiple factors are taken into consideration, including disease activity, coexisting morbidities, patient-based preference, and socioeconomic factors. Rituximab, has shown in numerous case series and reports, to be efficient and well tolerated. We report a female child with a relapsing, progressively debilitating CNS demyelinating disease with poor compliance to Disease-Modifying therapies, and breakthrough relapses during Interferon Beta-1b and Fingolimod trials. After rituximab therapy commencement, she had shown reduction in her annualized relapse rate, improvement in her disability scores; and stability in serial neuroimaging during the subsequent 27 months of regular follow-ups.