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An early and more aggressive therapeutic strategy may be useful in controlling disease activity in pediatric-onset multiple sclerosis, according to a new study. The presence of anti-EBV antibodies was associated with a less favorable prognosis for multiple sclerosis in children.

Multiple sclerosis (MS) is a demyelinating and inflammatory condition of the central nervous system. Between 3% and 5% of MS diagnoses occur in the pediatric population. Pediatric-onset multiple sclerosis (POMS) is associated with early progression to neurological disability and higher rates of relapse. 

This study investigated the clinical predictors implicated in disease control and progression by utilizing the “no evidence of disease activity-3” (NEDA-3) criteria. The findings are published in the journal Frontiers in Neuroscience.

Baseline Characteristics

The study included a total of 27 POMS patients, with 18 females and 9 males. The mean age of the study participants was 14.8 ± 2.8 years. All the patients had a diagnosis of relapsing–remitting MS and the median Expanded Disability Status Scale (EDSS) score was 1.5. Four of the patients had a family history of MS.

Attainment of NEDA-3 Status in Multiple Sclerosis Patients

The NEDA-3 status was achieved in nine patients at 12 months following the diagnosis of MS. All 27 patients fulfilled the conditions for absence of progression in neurological disability, a component of the NEDA-3 criteria. However, 21 patients met the criterion of absence of clinical relapses, and only 11 patients met the criterion of absence of MRI activity of disease.

Multiple Sclerosis and Therapeutic Strategies

In the context of disease-modifying therapy,all patients who were administered natalizumab achieved the NEDA-3 status. The NEDA-3 achievement was significantly associated with the use of natalizumab. The group of NEDA-3 patients who did not achieve the criteria (NEDA-3−) also differed significantly from the group of NEDA-3 patients who achieved the criteria (NEDA-3+) on the basis of the presence of anti-EBV antibodies. Patients without anti-EBV antibodies attained the NEDA-3 status.

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NEDA-3 Criteria and Therapeutic Strategies

Disease-modifying treatment was significantly different across the NEDA-3− and NEDA-3+ groups based on the criteria of absence of MRI evidence for disease activity. This criterion was strongly associated with immunomodulatory treatment. While there was a positive association between the absence of MRI evidence for disease activity and natalizumab treatment, glatiramer acetate treatment was negatively associated with this criterion.


Palavra, F., Silva, D., Fernandes, C., Faustino, R., Vasconcelos, M., Pereira, C. S., Costa, C., Ribeiro, J., Amaral, J., & Robalo, C. (2023b). Clinical predictors of NEDA-3 one year after diagnosis of pediatric multiple sclerosis: an exploratory single-center study. Frontiers in Neuroscience, 17. https://doi.org/10.3389/fnins.2023.1259306