Determining DMT Timing in Radiologically Isolated Syndrome: Ilena George, MD


The neurologist from Massachusetts General Hospital discussed when to prescribe disease-modifying therapy and some challenges in caring for patients with RIS.

“It is a little bit of an open question whether disease activity by itself, meaning MRI change over time, should be enough to prompt an initiation of a disease-modifying therapy... I think our study adds a little more data to this question.”

A recent study found that disease modifying therapy (DMT) is being prescribed to patients with radiologically isolated syndrome (RIS), often a precursor for multiple sclerosis (MS), at higher rates than previously seen. These findings were presented at the Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS) Forum 2021, February 25-27, by Ilena George, MD, neurologist, Massachusetts General Hospital.

George and colleagues found that first-line DMTs included dimethyl fumarate (n = 7), glatiramer acetate (n = 5), teriflunomide (n = 4), ocrelizumab (n = 2) and fingolimod (n = 1). Physician rationales for prescribing DMT included newly gadolinium-enhancing lesions (n = 13; 65%). Other reasons included clinical suspicion for a high risk of conversion to MS, (n = 6; 30%), and/or a high burden of CNS demyelinating disease on MRI, (n = 4; 20%).

NeurologyLive spoke with George to learn more about how her team’s investigation helps add to the body of literature on the question of prescribing DMT in RIS. She also spoke about ongoing and future studies in this area.

For more coverage of ACTRIMS Forum 2021, click here.

George IC, Rice DR, Chibnik L, Mateen FJ. Prevalence and use of disease modifying therapy in radiologically isolated syndrome (RIS): A retrospective study. Presented at ACTRIMS Annual Forum; February 25-27, 2021. Poster P168.
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