Disease modifying treatment of radiologically isolated syndrome: A systematic review of the use, efficacy, effectiveness, and safety.

IF 2.3 4区医学 Q2 CLINICAL NEUROLOGY

Revue neurologique Pub Date : 2025-10-15 DOI:10.1016/j.neurol.2025.09.005

D Ripsman, H Tremlett, A Alzahrani, N Makhani

{"title":"Disease modifying treatment of radiologically isolated syndrome: A systematic review of the use, efficacy, effectiveness, and safety.","authors":"D Ripsman, H Tremlett, A Alzahrani, N Makhani","doi":"10.1016/j.neurol.2025.09.005","DOIUrl":null,"url":null,"abstract":"Background: Radiologically isolated syndrome (RIS) is characterized by incidental brain lesions suggestive of demyelination without symptoms of multiple sclerosis (MS). We systematically assessed the use, benefits, and adverse effects of DMTs for RIS.Methods: MEDLINE, EMBASE, and Web of Science were searched to identify English language studies including individuals with RIS treated with a DMT. Extracted data included patient characteristics, clinical progression, and adverse events. We conducted a meta-analysis using inverse probability weighting. Risk of bias (RoB) assessments used Cochrane's RoB-2 tool and Newcastle-Ottawa cohort study scale.Results: A total of 1012 abstracts were screened: 20 studies were included consisting of 2 RCTs, 12 observational cohort studies, and 6 case reports. A total of 1401 individuals with RIS were included; 291 (21%) received a DMT. The two RCTs randomized people with RIS to teriflunomide or dimethyl fumarate versus placebo and followed patients for at least 96weeks. In all other studies, follow-up ranged from 2months to 18years; only 3 studies exceeded 5years. DMT treatment was associated with a lower risk of a clinical demyelinating event (4 studies with different DMTs, adjusted hazard ratio=0.37 95% confidence interval [CI]: 0.15-0.95, high certainty). There was a higher rate of adverse events in DMT treated patients with RIS versus placebo (risk ratio=1.44, 95% CI: 1.09-1.90, moderate certainty). RoB was low for both RCTs, but high for 83% (10/12) of cohort studies.Conclusions: DMTs reduced the risk of a clinical demyelinating event in individuals with RIS, albeit with more adverse events compared to placebo. However, no literature addressed longer-term benefits/adverse effects.","PeriodicalId":21321,"journal":{"name":"Revue neurologique","volume":" ","pages":""},"PeriodicalIF":2.3000,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Revue neurologique","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.neurol.2025.09.005","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Background: Radiologically isolated syndrome (RIS) is characterized by incidental brain lesions suggestive of demyelination without symptoms of multiple sclerosis (MS). We systematically assessed the use, benefits, and adverse effects of DMTs for RIS.

Methods: MEDLINE, EMBASE, and Web of Science were searched to identify English language studies including individuals with RIS treated with a DMT. Extracted data included patient characteristics, clinical progression, and adverse events. We conducted a meta-analysis using inverse probability weighting. Risk of bias (RoB) assessments used Cochrane's RoB-2 tool and Newcastle-Ottawa cohort study scale.

Results: A total of 1012 abstracts were screened: 20 studies were included consisting of 2 RCTs, 12 observational cohort studies, and 6 case reports. A total of 1401 individuals with RIS were included; 291 (21%) received a DMT. The two RCTs randomized people with RIS to teriflunomide or dimethyl fumarate versus placebo and followed patients for at least 96weeks. In all other studies, follow-up ranged from 2months to 18years; only 3 studies exceeded 5years. DMT treatment was associated with a lower risk of a clinical demyelinating event (4 studies with different DMTs, adjusted hazard ratio=0.37 95% confidence interval [CI]: 0.15-0.95, high certainty). There was a higher rate of adverse events in DMT treated patients with RIS versus placebo (risk ratio=1.44, 95% CI: 1.09-1.90, moderate certainty). RoB was low for both RCTs, but high for 83% (10/12) of cohort studies.

Conclusions: DMTs reduced the risk of a clinical demyelinating event in individuals with RIS, albeit with more adverse events compared to placebo. However, no literature addressed longer-term benefits/adverse effects.

查看原文本刊更多论文

放射孤立综合征的疾病改善治疗：使用、疗效、有效性和安全性的系统回顾。

背景：放射学孤立综合征（RIS）的特征是偶然的脑损伤提示脱髓鞘，没有多发性硬化症（MS）的症状。我们系统地评估了dmt治疗RIS的使用、益处和不良反应。方法：检索MEDLINE、EMBASE和Web of Science以确定英语语言研究，包括接受DMT治疗的RIS患者。提取的数据包括患者特征、临床进展和不良事件。我们使用逆概率加权进行了荟萃分析。偏倚风险（RoB）评估采用Cochrane的RoB-2工具和Newcastle-Ottawa队列研究量表。结果：共筛选1012篇摘要，纳入20项研究，包括2项随机对照试验、12项观察性队列研究和6例病例报告。共纳入1401例RIS患者；291例（21%）接受了DMT。这两项随机对照试验将RIS患者随机分为特立氟米特或富马酸二甲酯与安慰剂，并对患者进行至少96周的随访。在所有其他研究中，随访时间从2个月到18年不等；只有3项研究超过了5年。DMT治疗与临床脱髓鞘事件的风险较低相关（4项采用不同DMT治疗的研究，校正风险比=0.37 95%可信区间[CI]: 0.15-0.95，高确定性）。与安慰剂相比，接受DMT治疗的RIS患者的不良事件发生率更高（风险比=1.44,95% CI: 1.09-1.90，中等确定性）。两项随机对照试验的RoB都较低，但83%（10/12）的队列研究的RoB较高。结论：dmt降低了RIS患者临床脱髓鞘事件的风险，尽管与安慰剂相比有更多的不良事件。然而，没有文献涉及长期益处/副作用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Revue neurologique 医学-临床神经学

CiteScore

4.80

自引率

0.00%

发文量

598

审稿时长

55 days

期刊介绍： The first issue of the Revue Neurologique, featuring an original article by Jean-Martin Charcot, was published on February 28th, 1893. Six years later, the French Society of Neurology (SFN) adopted this journal as its official publication in the year of its foundation, 1899. The Revue Neurologique was published throughout the 20th century without interruption and is indexed in all international databases (including Current Contents, Pubmed, Scopus). Ten annual issues provide original peer-reviewed clinical and research articles, and review articles giving up-to-date insights in all areas of neurology. The Revue Neurologique also publishes guidelines and recommendations. The Revue Neurologique publishes original articles, brief reports, general reviews, editorials, and letters to the editor as well as correspondence concerning articles previously published in the journal in the correspondence column.