Radiologically isolated syndrome (RIS) is a rare and relatively recent condition in which people have multiple sclerosis (MS)-like brain and spinal cord lesions without showing disease activity. But since the establishment of the RIS diagnosis, researchers have not reached an agreement on whether these patients should receive MS disease-modifying therapies.
At the 7th Joint ECTRIMS-ACTRIMS Meeting Oct. 25-28 in Paris, two researchers met for a debate on the topic.
Darin T. Okuda from the University of Texas Southwestern Medical Center argued that RIS presents a “remarkable opportunity” to stop potential disease — with resulting disability — in its tracks.
He based his argument on the fact that magnetic resonance imaging (MRI) lesions found in RIS patients are identical to those seen in patients with MS in terms of lesion size, number, and spatial spread, suggesting the presence of an autoimmune-based injury in their brain or spinal cord.
RIS patients are at high risk of developing MS, including primary progressive disease, and studies confirm that people with RIS have an increased risk of developing additional lesions that signal inflammatory demyelinating events. Some also show features of early neurodegeneration before they start developing symptoms, Okuda said.
“The management of chronic conditions involves interventions within the asymptomatic phase to reduce morbidity and mortality,” he said, referring to diseases like diabetes. “Given the existing natural history data [of RIS], the early introduction of DMTs [disease-modifying therapies] is highly reasonable,” he added, emphasizing that treatment, nonetheless, must be rational.
DMTs present a viable approach, aiming to lower the probability of future disability while preserving quality of life, he said.
Okuda also offered a provocative question at his presentation: “Would our concerns regarding treatment in RIS be different if the costs of DMTs were not so exorbitant or if the treatments were substantially safer?”
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