Jason Freeman, MD, MBA, and Stephen Yeung, DO, discuss updates on MRI International Guidelines presented at CMSC 2023. Sponsored by Novartis.
Jason Freeman, MD, MBA: Welcome to CMSC 2023. I am your host, Dr Jason Freeman, Medical Director, Novartis Medical Affairs, providing you with updates from CMSC 2023. The information herein is provided for disease educational purposes only, and is not intended to be, nor does it imply medical or diagnostic advice.
Jason Freeman, MD, MBA: So, the first topic we're going to cover is MRI and International Guidelines. Joining me today to discuss this is Dr Stephen Yeung, also a Medical Director with Novartis Pharmaceuticals. Dr Yeung, welcome to the program.
Stephen Yeung, DO: Thanks for having me.
Jason Freeman, MD, MBA: Dr Yeung, given that MRI is used in both the diagnosis and monitoring of MS, what recommendations or guidelines are available to help physicians out there in clinical practice? What are the guidelines that you typically use as you look to help treat and monitor your patients?
Stephen Yeung, DO: So, I think a popular and sort of reliable source for looking at- for guidance on how to monitor or utilize MRI as a biomarker for MS patients is certainly the MAGNIMS [Magnetic Resonance Imaging in MS] position paper in '21. It really kind of clearly highlights utility of MRI, not only in diagnoses, but certainly kind of measuring for treatment response. So, therefore, kind of when I would start a patient or either switch a patient to a new DMT, obtain a new baseline MRI at minimum 3 months after starting or initiating that new therapy. And then certainly after establishing kind of treatment response or obtaining a new baseline after that, then going on and using MRI as a tool for monitoring disease stability or disease control. So, obtaining annual MRIs thereafter. And I think that the question or debate about using contrast on a regular basis, certainly kind of MAGNIMS I think states that contrast is not entirely necessary every year. And so, I think that I would offer it routinely to patients early if just recently started, or if they had some clinical concern that raised the suspicion for continued or new disease activity. So, utilize that opportunity to see if you can catch that on the scan. But otherwise, I think that if you've established kind of a patient to be succeeding and responding well to that treatment, I think that certainly as MAGNIMS kind of states, routine use of contrast is not absolutely necessary.
Jason Freeman, MD, MBA: So, just to summarize, sounds like you do the 3-month re-baselining, you're doing a yearly MRI, the contrast is a plus/minus depending on patient scenario and go from there. Any comments on any other guidelines? Anything from CMSC or from AAN that you would throw into the clinical practice mix?
Stephen Yeung, DO: I think at CMSC certainly it's nice to hear kind of the consortium advocate and continue supporting imaging the entire axis. I think that's sometimes kind of in clinical practice, payers do push back on entire axis scans. But as we know, I think that cord imaging or- is not always done practically, but certainly cord impact or cord involvement certainly have great implications on patient outcomes. So, I think that it's nice to see the consortium kind of follow through and support the utility of cord imaging.
Jason Freeman, MD, MBA: And so, in your opinion, what's the potential for harm if these recommendations aren't being followed? An MRI is not being done maybe as often as recommended?
Stephen Yeung, DO: I think that the obvious is you may not catch disease breakthrough. I think that it's- in this day and age when you have kind of an arsenal of treatments available that can offer great disease control, still the question remains, “Is there kind of something else you could offer a patient to achieve kind of better control?” So, I think that monitoring imaging for lesions, new lesions, active lesions. And as we know, moving into the future, some of the things like slowly enlarging lesions, this is going to be an ongoing and growing topic of great interest. And as new class of medications emerge that may address this in better ways kind of come and go through development, I think it's nice to kind of keep this in mind. So basically, I think that if you aren't routinely adhering or kind of following imaging guidelines, then certainly you are at risk for kind of not ensuring that patients have the best opportunity or kind of best kind of ability to achieve kind of what we can do for MS treatment and disease control today.
Jason Freeman, MD, MBA: Thank you. What were some of the challenges highlighted in this session in respect to routine use of MRI in clinical practice? Are- do you think there are any barriers that are being faced by clinicians or patients to getting their yearly scans?
Stephen Yeung, DO: I think that the routine challenge is to obtaining kind of routine imaging, certainly kind of is the hesitation to use contrast every time. Practically speaking, many patients don't enjoy obtaining MRIs. Payers don't- really are not keen on obtaining expensive imaging. So, I think that it's kind of practical logistics and unfortunately kind of challenges like that, that kind of keep this topic of conversation as far as kind of challenges to obtaining routine MRI. Other things that kind of may pop up, that pose, I think in a real-world conversation for routine imaging is kind of the implications on MRI safety for women who are pregnant, women who are breastfeeding. And so certainly that kind of is also discussed, I think, in clinic with patients.
Jason Freeman, MD, MBA: Any particular key takeaways, either changes in recommendations? Is everything the same? What are some of your takeaways from the session this year at CMSC?
Stephen Yeung, DO: Bottom line for me is really MRI is, for the foreseeable future, is certainly a biomarker or tool that is here to stay. It's not going anywhere. I think with all discussions on different biomarkers in development and being looked at, I think that MRI remains a powerful tool, kind of something that's tried and proven method for measuring disease activity, helping in the diagnosis and kind of certainly ensuring that patients do continue to do well on kind of their current treatment. So, I think that given that MRIs are implemented and standardized or easily standardized through kind of different clinics around the world and kind of still utilized in pharma trials, I think that it's going to be hard to kind of ever discuss replacing it completely. But certainly, I think we all eagerly await kind of other biomarkers to supplement. And I think the bottom line really is, the goal of MS treatment and care really is to give patients the best opportunity and afford them the kind of wide array of different tools that we can kind of enrich what we can do for them medically so that they do well and thrive.
Jason Freeman, MD, MBA: Dr Yeung, thank you for sharing your time and your expertise with us. We appreciate your review of this session on MRIs and from this year's CMSC 2023.
Jason Freeman, MD, MBA: Thank you for watching CMSC 2023 Updates with Novartis US Medical Affairs.
Transcript Edited for Clarity