Anti-CD20 Therapies in Pediatric Acquired Demyelinating Syndromes: Evidence Across MS, AQP4-IgG-Positive NMOSD and MOGAD - PubMed
4 hours ago
- #pediatric neurology
- #autoimmune diseases
- #B-cell therapies
- Anti-CD20 therapies are central in treating pediatric-acquired demyelinating syndromes, including multiple sclerosis (MS), AQP4+ NMOSD, and MOGAD.
- Rituximab, used off-label, effectively reduces relapse rates and MRI activity in pediatric MS and is the best-supported option for AQP4+ NMOSD.
- Ocrelizumab has advanced pediatric evidence from Phase 3 trials, showing superiority over fingolimod in reducing MRI activity and sustained B-cell depletion in MS.
- Evidence for ofatumumab in pediatric MS is limited, and no pediatric data exist for ocrelizumab or ofatumumab in AQP4+ NMOSD or MOGAD.
- Responses to rituximab in MOGAD vary, suggesting contributions from non-B-cell mechanisms, and require individualized monitoring.
- Anti-CD20 therapies are generally well-tolerated, with common but mild infusion reactions, infections, and manageable side effects like hypogammaglobulinemia.
- Future research needs include pediatric trials for new anti-CD20 agents, biomarkers for treatment durability, and long-term safety studies in children.