Promising Efficacy of Teriflunomide in Radiologically Isolated Syndrome: Christine Lebrun-Frenay, MD, PhD, FAAN

WATCH TIME: 4 minutes

"We’re glad to announce a demonstrated risk reduction of 63% favoring teriflunomide. After adjusting for age of diagnosis of RIS, gender, MRI metrics, the risk increased to 72% favoring the active arms. At the earliest stage of disease demyelinating spectrums, or preclinical MS, the study is positive, and the prescription of a disease-modifying treatment is efficient to prevent multiple sclerosis."

Radiologically isolated syndrome (RIS) is defined as an entity in where white matter lesions fulfilling the criteria for multiple sclerosis (MS) occur in patients who do not have a history of clinical demyelinating attack or alternative etiology. In the field, some have debated that RIS is not a true clinical diagnosis but is instead part of a continuum from health to disease, and that it cannot be recognized on the basis of imaging and clinical features.

Recent findings from the phase 3 TERIS study (NCT03122652) showed that treatment with teriflunomide (Aubagio; Sanofi), a previously approved agent for relapsing multiple sclerosis (MS), significantly reduced the time to first clinical event in patients with RIS, often considered the presymptomatic phase of MS. The results were presented by Christine Lebrun-Frenay, MD, PhD, FAAN during one of the emerging sciences sessions at the 2023 American Academy of Neurology (AAN) Annual Meeting, held April 22-27, in Boston, Massachusetts.¹

The study enrolled 124 patients and randomized 89 who fulfilled the 2009 RIS criteria. The cohort was randomly assigned 1:1 to either 14 mg of teriflunomide or placebo, with time to first event from study entry as the primary outcome measure. Standardized MRI studies of the brain and spinal cord were conducted at weeks 0, 48, 96, and clinical events. In the trial, index MRI motives for patients included headache (47%), follow-up neurological disease (18%), dizziness/vertigo (13.5%), ophthalmology (7%), and miscellaneous (14.5%).

Lebrun-Frenay, head of CRCSEP and coordinator of the Neurosciences Research Unit at Paris City University, sat down in an interview with NeurologyLive® to discuss the objective of the study, as well as the findings. She talked about how the study contributes to the understanding of treating preclinical MS. In addition, Lebrun-Frenay spoke about the implications of the study for clinicians in terms of prescribing DMTs for patients with RIS.

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Editor’s Note: Lebrun-Frenay disclosed for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Revue Neurologique.

REFERENCES
1. Lebrun-Frenay C, Siva A, Sormani MP, et al. Teriflunomide (Aubagio) extends the time to multiple sclerosis in radiologically isolated syndrome: the TERIS study. Presented at: 2023 AAN Annual Meeting; April 22-27; Boston, MA. ES2