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Lauren B. Krupp, MD, FAAN, provides comprehensive guidance on treating pediatric multiple sclerosis, emphasizing early intervention, high-efficacy therapies, and holistic family support.
In an interview with Pharmacy Times®, Lauren B. Krupp, MD, FAAN, director of the Multiple Sclerosis Comprehensive Care Center at NYU Langone Health, discussed the crucial aspects of managing multiple sclerosis (MS) in children and adolescents. The discussion was based on the presentation "Treatment of Pediatric Multiple Sclerosis in the Current Era," which Krupp participated in at the American Academy of Neurology (AAN) 2025 Annual Meeting in San Diego, California.
Krupp highlighted the importance of quick treatment initiation with high-efficacy therapies. Furthermore, Krupp explains that while many adult MS medications are used off-label for pediatric patients, they are generally effective and safe. Krupp also emphasizes the need for comprehensive monitoring through blood tests, MRIs, and clinical evaluations, and stresses the significance of a multidisciplinary approach that supports not just the patient but the entire family's emotional and psychological well-being.
Pharmacy Times: What are current treatment and management guidelines for patients with pediatric multiple sclerosis?
1. Start MS treatment quickly with high-efficacy therapies, using adult medications off-label when necessary.
2. Implement comprehensive monitoring through regular laboratory tests, neuroimaging, and clinical evaluations.
3. Provide holistic support that addresses the emotional and psychosocial needs of both the patient and their family.
Lauren B. Krupp, MD, FAAN: In general, it's important that people with MS get started on treatment quickly, as soon as the diagnosis is established. And in general, the recommendation is to begin with high-efficacy therapies. Now, at this point in time, many of the high-efficacy therapies that are used for adults with MS are not yet FDA approved for pediatric MS, so one may find oneself in this situation of using an off-label medication. Fortunately, the biologic features of pediatric MS are sufficiently similar to those of adult MS that you can use these medications that are used for adults with a good degree of confidence that you're going to have a similar efficacy and safety profile. That's particularly true for the adolescents; very young children are a different situation. Those who are under 40 kilos may need to dose differently than they would otherwise. The other factor, of course, is patients going on these therapies need monitoring. What that means is, depending on what the medication is, it may require frequent blood tests up to every 3 months, looking for titers to viruses, liver function tests, or, in other cases, the medications may require monitoring that's a bit less frequent, but still at least a few times a year or twice a year. We generally like to repeat an MRI 6 months after a new therapy has been started to see that the medication is effective. We might want to do another MRI a year later from that. The monitoring really is laboratory, neuroimaging, and clinical evaluations.
Pharmacy Times: How could pharmacists play a role in counseling patients and their caregivers on treatment and rehabilitation strategies?
Krupp: The pharmacists can provide tremendous assistance here because they know the medications, and they're familiar with the complications and the side effects. The good news is that the vast majority of children and adolescents with MS tolerate MS therapies, the ones that we use today, extremely well. In the prior decades, the therapies we used involved injections that were often given multiple times a week. Now, if you're on an injection therapy, it's only once a month, and more often, they're infusions that are less frequent than once a month in some cases. Overall, it's a much easier program for a child or adolescent to adhere to. Pharmacists can provide reassurance, education, and support, and all of that goes a long way in helping a family deal with this condition.
Pharmacy Times: What strategies can be implemented by a care team to ameliorate the emotional and psychosocial consequences of MS?
Krupp: When MS affects a child or an adolescent, it's really affecting the whole family. It's helpful to take into account how the parents are coping and how the siblings might be coping. It's also useful at times to speak to parents separately from the patient. If you're going to take that approach, it's very helpful if you have a nurse or a social worker or psychologist who can work with you in interviewing the family members and in providing each individual the kind of support that they need, because what a parent might need to hear may be a little different than what a patient might need to hear. Of course, you don't want to educate the family members differentially. Parents and children need to both learn that MS has a very, very excellent prognosis, but a parent may have worries that are different than what an adolescent is thinking about. Being able to use a team in a multidisciplinary manner can really be effective in helping everybody involved.
