title: [Is MRI monitoring useful in clinical practice in patients with multiple sclerosis? No].
abstract: Is regular MRI monitoring useful in clinical practice in multiple sclerosis patients treated with disease modifying therapy (DMT) drugs? My answer is no. Tacking a DMT drug is not by itself a pertinent criterion for requiring a systematic MRI monitoring in MS patients. Five clinical criteria should be taken into consideration before prescribing regular MRI examinations. The clinical form of the disease: MRI monitoring in DMT treated patients, has been demonstrated as useful only in pure relapsing-remitting MS patients. Up to now, there is no convincing demonstration of therapeutic efficacy with any DMT drug, neither first-line nor second-line drugs in patients with primary or secondary progressive MS disease. The duration of the disease, epidemiological data leading to the concept of a two-stage disability progression in MS, emphasizes the importance of treating as early as possible RRMS patients in order to stop accumulation of new focal MRI CNS lesions. In this regard, an annual monitoring for the 5 first years of the disease looks reasonable in order to better personalize the treatment choice among the few approved DMT drugs. The duration of the treatment: a first MRI assessment at month 6 after initiating a new DMT drug is adequate in order to better distinguish responder versus no responder. The persistence of Gado+lesions at 6 months is a strong indication for considering alternative treatment. The disease activity: both criteria, clinical and MRI, are needed to recognized very active or aggressive relapsing MS patients, leading to decide a rapid use of second-line treatment therapy. The treatment choice: in JC positive MS patients treated with natalizumab, the risk of PML is as high as more than 1 % in those JC+MS patients that are treated continuously more than 24 months. A regular MRI monitoring (3 or 6months) is recommended in order to detect as early as possible MRI abnormalities suggesting PML.
authors.affiliation: CIC-P 02 03 Inserm, service de neurologie, CHU Pontchaillou, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex 9, France. Electronic address: gilles.edan@chu-rennes.fr.
authors.forename: G
authors.initials: G
authors.lastname: Edan
mesh_terms: D003657:Decision Making; D018450:Disease Progression; D016021:Epidemiologic Studies; D006801:Humans; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging / Q000379:methods; D008991:Monitoring, Physiologic / Q000379:methods*; D009103:Multiple Sclerosis / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D011237:Predictive Value of Tests; D011364:Professional Practice
keywords: Disease modifying therapy (DMT) drugs; IRM; MRI; Multiple sclerosis; Sclérose en plaques; Traitement