Understanding Dimethyl Fumarate’s Impact on Radiologically Isolated Syndrome: Darin Okuda, MD, FAAN, FANA

WATCH TIME: 3 minutes

"It was wonderful to receive feedback from many in the field about our contribution to multiple sclerosis and our understanding of the early disease behavior within this phase of MS. It’s very important to highlight that we had limited options back in the day with respect to treatments."

Introduced in 2009, radiologically isolated syndrome (RIS) refers to an entity in which white matter lesions fulfilling the criteria for multiple sclerosis (MS) occur in individuals without a history a clinical demyelinating attack or alternative etiology. Some in the field have argued that RIS is not truly a clinical diagnosis and instead is part of a continuum of health to disease that cannot be distinguished on the basis of imaging and clinical features. There is no cure for RIS and depending on the patient’s history, MRI results, and condition, observation may be the only treatment necessary.

RIS was first defined by Darin Okuda, MD, as showing T2-hyperintense, ovoid, homogenous, well-defined lesions on MRI that fulfilled at least 3 of 4 Barkhof criteria. More than a decade later, in 2022, he and his colleagues unveiled findings from the ARISE study (NCT02739542), the first trial to identify a disease-modifying effect in RIS through treatment. The drug used in the study was dimethyl fumarate (Tecfidera; Biogen), a nuclear factor 2 activator that received FDA-approval for relapsing MS in 2013.

The full dataset of ARISE was recently published in Annals of Neurology, with findings that showed a significant 82% reduction in risk of clinical demyelinating event over a 96-week treatment period. Okuda, director of Neuroinnovation and Multiple Sclerosis & Neuroimmunology Imaging Program at UT Southwestern Medical Center, sat down to describe the design of the study and the significance of these data.

REFERENCE
1. Okuda DT, Kantarci O, Lebrun-Frenay C, et al. Dimethyl fumarate delays multiple sclerosis radiologically isolated syndrome. Ann Neurol. Published online November 18, 2022. doi:10.1002/ana.26555