Clinically Isolated Syndrome Versus Multiple Sclerosis

Fred Lublin, MD: Coming back to 2017, has it made much difference in how you’re figuring out who to treat?

Sven Meuth, MD, PhD: In Germany, we had an ongoing discussion when we still worked with the concept of clinically isolated syndrome [CIS] and early relapsing-remitting MS [multiple sclerosis], and since we have the new criteria, my idea is that the group of patients with clinically isolated syndrome is now much smaller. This is also why we don’t have to discuss any more that some of the platform therapies are only approved for relapsing-remitting MS, but not for clinically isolated syndrome. This whole discussion stopped with the new criteria because we now have a chance to, early on, diagnose relapsing-remitting MS and to start treatment immediately. For us, it was quite helpful.

Patricia K. Coyle, MD: That’s an important difference in the United States where for CIS high risk, we’re able to treat that patient. Granted, greater than 50% of first attack patients will meet the 2017 criteria. But if you have a first attack and you fit for high risk for MS, and you’ve ruled out other things, you basically have relapsing MS. That’s your first attack, whether you met the criteria or not. We can treat those patients in the United States.

Fred Lublin, MD: Clinically isolated syndrome, we’ve been treating it in the United States without difficulty even before there was labeling here for a clinically isolated syndrome. Now, all are labeled for clinically isolated syndrome except for a couple of the more aggressive ones. You wouldn’t feel there is much difference between the first attack and the subsequent attack, but I know that regulatory authorities have had some issues with that.

Wallace Brownlee, MBChB, PhD, FRACP: As for insights, I think that, in Europe, the updated McDonald Criteria have been helpful, and they allow an earlier diagnosis of multiple sclerosis than previously and do open up new therapeutic opportunities for patients with relapsing MS.

Fred Lublin, MD: After the 2010 change, which had a big change in dissemination in time by allowing a single MRI to do that, the clinically isolated syndromes dropped by about 50%, because they then met criteria for MS. I don’t know what’s happened with 2017, whether that’s made a difference.

Wallace Brownlee, MBChB, PhD, FRACP: Some very early data that have come out of the Netherlands have shown that perhaps up to 70% of patients can now be diagnosed confidently with MS at the time of the first clinical attack that is highly suggestive of relapsing MS, like optic neuritis or partial myelitis.