Access to therapy for children and adolescents with multiple sclerosis: global considerations in preventing disease progression

Paediatric-onset multiple sclerosis comprises approximately 1·5% of prevalent multiple sclerosis cases and is associated with higher disease burden, early and progressive motor and cognitive disability in young adulthood, and high levels of depression and fatigue. Observational data and randomised controlled trials have shown marked effects of multiple sclerosis disease-modifying therapies on MRI activity and long-term outcomes, including disease progression, in the paediatric population. We present a comprehensive review of published literature focused on issues of access to therapy in children and adolescents with paediatric-onset multiple sclerosis. In this Review, we identify regional variability in availability of multiple sclerosis therapies and examine issues, such as differences in access to care and time to diagnosis, criteria for regulatory approval, availability of insurance, and government supports. Finally, we outline specific future directions that should be taken to address these barriers and ensure better and equal therapy access for all children and adolescents with multiple sclerosis.