Consensus opinion of US neurologists on practice patterns in RIS, CIS, and RRMS: Evolution of treatment practices

Abstract

Purpose of review: To assess current practice patterns of US neurologists in patients with radiologically isolated syndrome (RIS), clinically isolated syndrome (CIS), and relapsing-remitting multiple sclerosis (RRMS) using case-based Web surveys.

Recent findings: We identified a total of 47 points of consensus (≥75% agreement) with regard to diagnosis, treatment, and monitoring of RIS, CIS, and RRMS. Current US treatment consensus patterns emphasize (1) MRI in multiple sclerosis (MS) diagnosis and subsequent treatment decisions, (2) treatment of early disease, (3) aggressive initial treatment of highly active MS, and (4) close patient monitoring for clinical response and adverse effects of disease-modifying drugs.

Summary: These findings may offer insights into harmonizing MS care and represent the first steps in potentially establishing a more uniform approach to the treatment of patients with MS in the United States without compromising the need for individual treatment for each patient.

Figure 1. Treatment practices

CIS = clinically isolated syndrome; DMT = disease-modifying therapy; Gd+ = gadolinium-enhancing; JCV− = JC virus; RIS = radiologically isolated syndrome; RRMS = relapsing-remitting multiple sclerosis.

Figure 2. Choice of initial treatment in patient with relapsing-remitting multiple sclerosis with 2 clinical relapses in the last 4 years (1 within the last 6 months), brain hypointense T1 lesions, and brain atrophy (n = 101)

IFN = interferon; JCV = JC virus; SC = subcutaneous.