scholarly journals Long-term Cognitive Outcomes in Patients With Pediatric-Onset vs Adult-Onset Multiple Sclerosis

2019 ◽  
Vol 76 (9) ◽  
pp. 1028 ◽  
Author(s):  
Kyla A. McKay ◽  
Ali Manouchehrinia ◽  
Lindsay Berrigan ◽  
John D. Fisk ◽  
Tomas Olsson ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Cognitive Outcomes ◽  
Adult Onset ◽  
Pediatric Onset

Peripheral Blood Eosinophilia and Long-term Severity in Pediatric-Onset Inflammatory Bowel Disease

2020 ◽  
Vol 26 (12) ◽  
pp. 1890-1900
Author(s):  
Krishnapriya Marangattu Prathapan ◽  
Claudia Ramos Rivers ◽  
Alyce Anderson ◽  
Filippos Koutroumpakis ◽  
Ioannis E Koutroubakis ◽  
...  
Keyword(s):  
Health Care ◽  
Natural History ◽  
Peripheral Blood ◽  
Care Utilization ◽  
Adult Onset ◽  
Blood Eosinophilia ◽  
Inflammatory Bowel ◽  
Peripheral Blood Eosinophilia ◽  
Pediatric Onset

Abstract Background Peripheral blood eosinophilia (PBE) is a biomarker of an aggressive multiyear natural history in adults with inflammatory bowel diseases (IBDs). Additionally, PBE at diagnosis is associated with higher disease activity in pediatric-onset IBD. We sought to determine if PBE can function as a biomarker of long-term disease severity in pediatric-onset IBD patients who are followed into adulthood. Methods We analyzed a consented, prospective, natural history IBD registry at an adult tertiary center from 2009 to 2018. Prevalence of PBE was evaluated in both pediatric- and adult-onset IBD patients. Demographics, clinical characteristics, and health care utilization data were compared in patients with and without PBE. Results Among 2800 adult IBD patients, 23.4% had pediatric-onset disease. PBE was found in 34% of the pediatric-onset patients compared with 26.8% of the adult-onset IBD patients (P < 0.001). In the pediatric-onset IBD cohort, PBE was associated with higher rates of allergies (P < 0.0001), but not of asthma, allergic rhinitis, or primary sclerosing cholangitis. In the adult IBD patients with pediatric-onset disease, PBE was associated with higher rates of C-reactive protein elevation (P < 0.0001), erythrocyte sedimentation rate elevation (P < 0.0001), higher health care utilization, and higher average health care charges per year (P < 0.00001). Conclusions Peripheral blood eosinophilia was more prevalent in adult IBD patients with pediatric-onset compared with adult-onset disease. Among all IBD patients with long-term follow-up, PBE defined a subgroup with more severe illness. These data suggest that PBE may be a biomarker for a high-risk subgroup with high cost trajectory and long-term severity in pediatric-onset IBD that persists into adulthood.

scholarly journals Increased Relapse Rate in Pediatric-Onset Compared With Adult-Onset Multiple Sclerosis

2009 ◽  
Vol 66 (1) ◽  
Author(s):  
Mark P. Gorman ◽  
Brian C. Healy ◽  
Mariann Polgar-Turcsanyi ◽  
Tanuja Chitnis
Keyword(s):  
Multiple Sclerosis ◽  
Relapse Rate ◽  
Adult Onset ◽  
Pediatric Onset

scholarly journals Impact of Diagnostic Delay on Disease Course in Pediatric Versus Adult-onset Patients with Ulcerative Colitis: Data from the Swiss IBD Cohort

2021 ◽  
Author(s):  
Alain M. Schoepfer ◽  
Vu Dang Chau Tran ◽  
Jean-Benoit Rossel ◽  
Christiane Sokollik ◽  
Johannes Spalinger ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Ulcerative Colitis ◽  
Diagnostic Delay ◽  
Adult Patients ◽  
Adult Onset ◽  
Considerable Morbidity ◽  
The Impact ◽  
Onset Group ◽  
Pediatric Onset

Introduction: Given the lack of data we aimed to assess the impact of the length of diagnostic delay on natural history of ulcerative colitis in pediatric (diagnosed <18 years) and adult patients (diagnosed ≥18 years). Methods: Data from the Swiss Inflammatory Bowel Disease cohort study were analyzed. Diagnostic delay was defined as interval between the first appearance of UC-related symptoms until diagnosis. Logistic regression modeling evaluated the appearance of the following complications in the long term according to the length of diagnostic delay: colonic dysplasia, colorectal cancer, UC-related hospitalization, colectomy, and extra-intestinal manifestations (EIM). Results: A total of 184 pediatric and 846 adult patients were included. Median diagnostic delay was 4 [IQR 2-7.5] months for the pediatric-onset group and 3 [IQR 2-10] months for the adult-onset group (P=0.873). In both, pediatric and adult-onset groups, length of diagnostic delay at UC diagnosis was not associated with colectomy, UC-related hospitalization, colon dysplasia, and colorectal cancer. EIM were significantly more prevalent at UC diagnosis in the adult-onset group with long diagnostic delay compared to the adult-onset group with short diagnostic delay (p = 0.022). In the long term, length of diagnostic delay was associated in the adult onset group with colorectal dysplasia (p=0.023), EIMs (p<0.001) and more specifically arthritis/arthralgias (p<0.001) and ankylosing spondylitis/sacroiliitis (p<0.001). In the pediatric-onset UC group, length of diagnostic delay in the long term was associated with arthritis/arthralgias (p=0.017); however, it was not predictive for colectomy and UC-related hospitalization. Conclusions: As colorectal cancer and EIMs are associated with considerable morbidity and costs, every effort should be made to reduce diagnostic delay in UC patients.

Clinical Characteristics of Pediatric-Onset and Adult-Onset Multiple Sclerosis in Hispanic Americans

2016 ◽  
Vol 31 (8) ◽  
pp. 1068-1073 ◽  
Author(s):  
Megan M. Langille ◽  
Talat Islam ◽  
Margaret Burnett ◽  
Lilyana Amezcua
Keyword(s):  
Multiple Sclerosis ◽  
Clinical Characteristics ◽  
Hispanic Americans ◽  
Adult Onset ◽  
Pediatric Onset

scholarly journals Long-Term Treatment Strategies of Pediatric Multiple Sclerosis, Including the use of Disease Modifying Therapies

Children ◽  
2019 ◽  
Vol 6 (6) ◽  
pp. 73 ◽  
Author(s):  
Mary Rensel
Keyword(s):  
Multiple Sclerosis ◽  
Clinical Trials ◽  
Term Treatment ◽  
Treatment Goals ◽  
Adult Onset ◽  
Disease Modifying Therapies ◽  
New Concepts ◽  
Long Term Treatment ◽  
Disease Modifying

Multiple sclerosis (MS) presenting in the pediatric years can lead to landmark disability levels younger in life than adult onset MS and so therefore early and effective treatment remains paramount for long-term outcomes. The goals of MS therapeutics in adults have widened to address multiple mechanisms: anti-inflammatory, neuroprotective, and myelin repair, yet the optimal paradigm for MS therapies in the pediatric population is not known. Pediatric onset MS add complexities due to the ongoing development of the central nervous system and the immune system. Clinical trials have led to an increasing number of pharmaceutical therapies for adult onset MS (AOMS), one POMS randomized controlled trial is completed and other trials are ongoing, yet due to the low prevalence of POMS, the dynamic landscape and risk management of the MS disease modifying therapies (DMT) it remains more difficult to complete trials in POMS. There is consensus that controlled clinical trials leading to appropriate and safe therapies for POMS are important for a multitude of reasons that include unique pediatric pharmacokinetics, short and long-term safety, developmental issues, clinical benefits, and regulatory approval. This review will focus on new treatment goals, paradigm, strategies, monitoring, compliance, and products in the long-term treatment of POMS. The discussion will focus on these new concepts and the published data related to DMT use in POMS. This review provides significant insight into new concepts of treatment goals and current approaches to enhance the lives of the POMS patients now and in the future.

scholarly journals Long-term disability progression of pediatric-onset multiple sclerosis

Neurology ◽  
2019 ◽  
Vol 92 (24) ◽  
pp. e2764-e2773 ◽  
Author(s):  
Kyla A. McKay ◽  
Jan Hillert ◽  
Ali Manouchehrinia
Keyword(s):  
Multiple Sclerosis ◽  
Proportional Hazards ◽  
Clinical Information ◽  
Cox Proportional Hazards ◽  
Disability Progression ◽  
Kaplan Meier ◽  
Younger Age ◽  
Risk Of Progression ◽  
Pediatric Onset

ObjectiveTo evaluate long-term disability progression in pediatric-onset multiple sclerosis (POMS) and compare to adult-onset multiple sclerosis (AOMS).MethodsThis was a retrospective cohort study using prospectively collected clinical information from the Swedish MS Registry. Clinical features were compared and Kaplan-Meier and Cox proportional hazards regression were used to assess the risk of reaching sustained Expanded Disability Status Scale (EDSS) 3, 4, and 6 in POMS (multiple sclerosis [MS] onset <18 years) and AOMS (MS onset ≥18 years).ResultsA total of 12,482 persons were included; 549 (4.4%) were classified as POMS. The POMS cohort took longer to reach all 3 disability milestones from their MS onset, but did so at a younger age than the AOMS cohort. Primary progressive course (hazard ratio [HR] 4.63; 95% confidence interval [CI] 1.46–14.7), higher relapse rate in the first 5 years of disease (HR 5.35; 95% CI 3.37–8.49), and complete remission from the initial relapse (HR 0.41; 95% CI 0.18–0.94) were associated with an altered risk of progression to EDSS 4 among POMS cases. The same pattern emerged for the risk of reaching EDSS 3 and 6.ConclusionsPatients with pediatric-onset MS follow a distinctive clinical course, which should be considered in the treatment and management of the disease.

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