{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T01:36:41Z","timestamp":1784857001019,"version":"3.55.0"},"reference-count":39,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2025,11,6]],"date-time":"2025-11-06T00:00:00Z","timestamp":1762387200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2025,11,6]],"date-time":"2025-11-06T00:00:00Z","timestamp":1762387200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000890","name":"National Multiple Sclerosis Society","doi-asserted-by":"publisher","award":["HC\u20101509\u201006233"],"award-info":[{"award-number":["HC\u20101509\u201006233"]}],"id":[{"id":"10.13039\/100000890","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Annals of Neurology"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To assess real\u2010world effectiveness of switching disease\u2010modifying therapy (DMT) in pediatric multiple sclerosis (MS) and clinically isolated syndrome (CIS) initially treated with platform injectables on disease activity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Of 2615 pediatric\u2010onset demyelinating disease patients at 12 clinics in the United States (US) Network of Pediatric MS Centers, those with MS\/CIS on initial therapy with a platform injectable who switched to another class of platform injectable, oral or infusion DMT were analyzed. Relapse rate was modeled with negative binomial regression, adjusted for preidentified confounders.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 212 children switched DMT before age 18 (67% female, 95% MS). Ninety\u2010three switched from injectable to injectable, 76 injectable to oral, and 43 injectable to infusion. Switchers to oral or infusion were older at onset (injectable 12.3\u2009years, oral 13.5\u2009years, and infusion 14.2\u2009years) and switch (injectable 14.6\u2009years, oral 16.0\u2009years, and infusion 15.7\u2009years). Switchers to infusion DMT were more likely to have enhancing lesions (injectable 45%, oral 28%, and infusion 67%). Compared to injectable (annualized relapse rate [ARR] =\u20090.88, 95% confidence interval [CI] =\u20090.52\u20131.48), relapse rates were lower for injectable to oral (ARR\u2009=\u20090.34, 95% CI\u2009=\u20090.20\u20130.57; rate ratio: 0.38, 95% CI\u2009=\u20090.21\u20130.69) and injectable to infusion (ARR\u2009=\u20090.18, 95% CI\u2009=\u20090.09\u20130.37; rate ratio: 0.21, 95% CI\u2009=\u20090.10\u20130.44) (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Adjusted number needed to treat in person\u2010years to prevent 1 relapse with oral over injectable was 1.84 (95% CI\u2009=\u20091.03\u20138.69) and infusion over injectable 1.43 (95% CI\u2009=\u20091.00\u20133.88).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interpretation<\/jats:title>\n                    <jats:p>Switching from platform injectable to oral or infusion compared to other platform injectable DMT led to better disease control in pediatric MS. Long\u2010term safety data are required. ANN NEUROL 2026;99:715\u2013729<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ana.78086","type":"journal-article","created":{"date-parts":[[2025,11,6]],"date-time":"2025-11-06T11:19:24Z","timestamp":1762427964000},"page":"715-729","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Real\u2010World Effectiveness of Switching to Oral or Infusion Versus Injectable Disease\u2010Modifying Therapy in Pediatric Multiple Sclerosis"],"prefix":"10.1002","volume":"99","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4607-5740","authenticated-orcid":false,"given":"Aaron W.","family":"Abrams","sequence":"first","affiliation":[{"name":"Department of Neurology Cleveland Clinic  Cleveland OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Waltz","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of Utah  Salt Lake City UT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T. Charles","family":"Casper","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of Utah  Salt Lake City UT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory","family":"Aaen","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Loma Linda University  San Bernardino CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leslie A.","family":"Benson","sequence":"additional","affiliation":[{"name":"Department of Neurology Boston Children's Hospital  Boston MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva\u2010Chava M.","family":"Bernfeld","sequence":"additional","affiliation":[{"name":"Department of Neurology Cleveland Clinic  Cleveland OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4429-9713","authenticated-orcid":false,"given":"Leigh E.","family":"Charvet","sequence":"additional","affiliation":[{"name":"Department of Neurology New York University Langone Health  New York NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tanuja","family":"Chitnis","sequence":"additional","affiliation":[{"name":"Department of Pediatric Neurology Massachusetts General Hospital  Boston MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carla","family":"Francisco","sequence":"additional","affiliation":[{"name":"Department of Neurology University of California  San Francisco CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark P.","family":"Gorman","sequence":"additional","affiliation":[{"name":"Department of Neurology Boston Children's Hospital  Boston MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer S.","family":"Graves","sequence":"additional","affiliation":[{"name":"Department of Neurology University of California, San Diego  La Jolla CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7003-807X","authenticated-orcid":false,"given":"Lauren","family":"Krupp","sequence":"additional","affiliation":[{"name":"Department of Neurology New York University Langone Health  New York NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6021-8683","authenticated-orcid":false,"given":"Kimberly","family":"O'Neill","sequence":"additional","affiliation":[{"name":"Department of Neurology New York University Langone Health  New York NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy E.","family":"Lotze","sequence":"additional","affiliation":[{"name":"Department of Neurology Texas Children's Hospital  Houston TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soe","family":"Mar","sequence":"additional","affiliation":[{"name":"Department of Neurology Washington University in Saint Louis  St Louis MO"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jayne","family":"Ness","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of Alabama at Birmingham  Birmingham AL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary","family":"Rensel","sequence":"additional","affiliation":[{"name":"Department of Neurology Cleveland Clinic  Cleveland OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moses","family":"Rodriguez","sequence":"additional","affiliation":[{"name":"Department of Neurology Mayo Clinic  Rochester MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Rose","sequence":"additional","affiliation":[{"name":"Department of Neurology University of Utah  Salt Lake City UT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alice","family":"Rutatangwa","sequence":"additional","affiliation":[{"name":"Department of Neurology University of California  San Francisco CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teri","family":"Schreiner","sequence":"additional","affiliation":[{"name":"Department of Neurology and Pediatrics University of Colorado  Aurora CO"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikita","family":"Shukla","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Neurology Dell Children's Hospital, University of Texas  Austin TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan\u2010Mendelt","family":"Tillema","sequence":"additional","affiliation":[{"name":"Department of Neurology Mayo Clinic  Rochester MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bianca","family":"Weinstock\u2010Guttman","sequence":"additional","affiliation":[{"name":"Department of Neurology State University of New York at Buffalo  Buffalo NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yolanda","family":"Wheeler","sequence":"additional","affiliation":[{"name":"Department of Nursing University of Alabama at Birmingham  Birmingham AL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5188-0157","authenticated-orcid":false,"given":"Emmanuelle","family":"Waubant","sequence":"additional","affiliation":[{"name":"Department of Neurology University of California  San Francisco CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0090-597X","authenticated-orcid":false,"given":"Kristen M.","family":"Krysko","sequence":"additional","affiliation":[{"name":"Division of Neurology, Department of Medicine BARLO MS Centre, St. Michael's Hospital, Li Ka Shing Knowledge Institute, University of Toronto  Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the US Network of Pediatric MS Centers","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,11,6]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1177\/0883073819845827"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/archneurol.2008.505"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0085741"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awp278"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000007647"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2022.824926"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1800149"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/ana.25737"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.msard.2019.101431"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.msard.2021.103277"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1212\/NXI.0000000000001008"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.msard.2023.104942"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1177\/1352458518754364"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejpn.2023.05.001"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejpn.2023.06.011"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2023.5566"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10072-022-06431-y"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1177\/0883073814550656"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1177\/1352458513484547"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/ana.22366"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(17)30470-2"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1002\/9780470316696"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1002\/pst.1650"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-1-4614-1353-0"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1177\/0962280209105023"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa044397"},{"key":"e_1_2_9_28_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1601277"},{"key":"e_1_2_9_29_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000006471"},{"key":"e_1_2_9_30_1","doi-asserted-by":"publisher","DOI":"10.1111\/ene.16228"},{"key":"e_1_2_9_31_1","doi-asserted-by":"publisher","DOI":"10.3389\/fnins.2023.1259306"},{"key":"e_1_2_9_32_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10072-022-06211-8"},{"key":"e_1_2_9_33_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00210-022-02238-y"},{"key":"e_1_2_9_34_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000208114"},{"key":"e_1_2_9_35_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-024-12610-y"},{"key":"e_1_2_9_36_1","doi-asserted-by":"publisher","DOI":"10.1212\/NXI.0000000000200303"},{"key":"e_1_2_9_37_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2352-4642(24)00047-6"},{"key":"e_1_2_9_38_1","doi-asserted-by":"publisher","DOI":"10.17116\/jnevro2023123092100"},{"key":"e_1_2_9_39_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.msard.2023.104962"},{"key":"e_1_2_9_40_1","doi-asserted-by":"publisher","DOI":"10.7224\/1537-2073.2019-095"}],"container-title":["Annals of Neurology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ana.78086","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ana.78086","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ana.78086","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T15:36:22Z","timestamp":1772984182000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ana.78086"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,6]]},"references-count":39,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,3]]}},"alternative-id":["10.1002\/ana.78086"],"URL":"https:\/\/doi.org\/10.1002\/ana.78086","archive":["Portico"],"relation":{},"ISSN":["0364-5134","1531-8249"],"issn-type":[{"value":"0364-5134","type":"print"},{"value":"1531-8249","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,6]]},"assertion":[{"value":"2025-03-31","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-10-16","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-11-06","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}