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Practice patterns of US neurologists in patients with CIS, RRMS, or RIS: A consensus study
Carlo Tornatore1, J Theodore Phillips, Omar Khan
1Georgetown University Hospital (CT), Washington, DC; Baylor Institute for Immunology Research (JTP), Dallas, TX; Wayne State University School of Medicine (OK), Detroit, MI; Mount Sinai School of Medicine (AEM), New York, NY; and Infusion Communications (CJB), Haddam, CT.
US neurologists frequently recommend disease-modifying therapy (DMT) for early multiple sclerosis (MS) and clinically isolated syndrome (CIS) with MRI evidence. Treatment for highly active MS shows consensus, but therapy choice varies, while radiologically isolated syndrome (RIS) without spinal lesions is not treated.
Area of Science:
- Neurology
- Neuroimmunology
- Clinical Practice
Background:
- Multiple Sclerosis (MS) diagnosis and treatment have evolved, with increasing emphasis on early intervention and Magnetic Resonance Imaging (MRI) findings.
- Clinically Isolated Syndrome (CIS), Relapsing-Remitting Multiple Sclerosis (RRMS), and Radiologically Isolated Syndrome (RIS) represent different stages or presentations of MS spectrum disorders.
- Understanding current US neurologists' practice patterns is crucial for evaluating diagnostic and therapeutic strategies in MS management.
Purpose of the Study:
- To evaluate current US neurologists' practice patterns for managing patients with CIS, RRMS, and RIS.
- To identify consensus and variations in treatment recommendations based on clinical and radiological findings.
- To assess the role of MRI in diagnosis and treatment decisions for early MS and related syndromes.
Main Methods:
- Case-based surveys were administered to US neurologists.
- Practice patterns were assessed for patients presenting with CIS, RRMS, and RIS.
- Data analysis focused on treatment initiation, therapy choices, and the influence of MRI findings.
Main Results:
- 87% of neurologists recommended disease-modifying therapy (DMT) for CIS with brain MRI lesions.
- 90%-98% recommended injectable DMT for treatment-naive, mild RRMS patients.
- 97% consensus existed for treating highly active RRMS, but therapy choice lacked consensus.
- Consensus was against initiating treatment for RIS with brain but no spinal MRI lesions.
Conclusions:
- Current US treatment patterns for MS emphasize the importance of MRI in diagnosis and treatment decisions.
- There is a trend towards early treatment initiation for CIS and mild RRMS.
- Aggressive initial treatment for highly active MS is generally agreed upon, though specific therapy choices vary.
- Radiologically Isolated Syndrome (RIS) without spinal MRI evidence is typically not treated, reflecting a cautious approach based on lesion location.
