Should Radiologically Isolated Syndrome Be Treated with a Disease-Modifying Therapy?

Since the introduction in 2009 of an entity known as radiologically isolated syndrome (RIS), in which white-matter lesions fulfilling the criteria for multiple sclerosis are seen in patients without a history of a clinical demyelinating attack or alternative etiology and a strictly normal neurological examination, its clinical relevance has been debated extensively by neurologists and radiologists.

In this multicenter, randomized, double-blinded, placebo-controlled study of patients with RIS from 12 tertiary-care centers in the U.S., 44 individuals were randomly assigned to dimethyl fumarate (DMF) and 43 to placebo for 96 weeks. Results were consistent with a significant effect of DMF on reducing the risk for a first relapse, corresponding t…