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Clinical data were collected from the medical record and all contrast-enhanced brain magnetic resonance images (MRIs) were re-reviewed by a neuroradiologist for standardized T2 lesion counts. Median treatment duration was 126 weeks. After rituximab became therapeutically active (\u22656 months after initiation), no clinical relapses occurred. Sixteen patients (94%) achieved a clinical\u2009+\u2009MRI activity-free composite outcome (no relapses and no new\/enlarging T2 or gadolinium-enhancing lesions). Total T2 lesion counts were stable or decreased in all patients compared with the post-induction baseline. Adverse events were infrequent with no serious adverse events reported. These findings provide preliminary support for rituximab as a well-tolerated, first-line high-efficacy approach in POMS and warrant larger prospective studies.<\/jats:p>","DOI":"10.1177\/08830738261452770","type":"journal-article","created":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T09:39:01Z","timestamp":1780393141000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["First-Line Rituximab in Pediatric-Onset Multiple Sclerosis: Clinical and MRI Outcomes in a Retrospective Cohort"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4072-943X","authenticated-orcid":false,"given":"Hannah","family":"Lewis","sequence":"first","affiliation":[{"name":"University of Arkansas for Medical Sciences"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Kiss","sequence":"additional","affiliation":[{"name":"Division of Neurology, Arkansas Children's 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