DELPHI expert consensus-derived factors influencing the early use of monoclonal high-efficacy therapies in treatment-naïve patients with relapsing-remitting multiple sclerosis

Abstract Objective To gather expert consensus regarding initiation of monoclonal high-efficacy therapies (HET) amongst treatment-naïve relapsing-remitting multiple sclerosis (RRMS) patients in France. Methods The study leveraged the Delphi method to gauge consensus amongst an expert panel of 31 neurologists. Eight clinical cases with demographic, clinical and imaging characteristics were presented, prompting the experts to respond if they would recommend monoclonal HET. Additionally, potentially influential parameters were changed one at a time to assess whether the experts would recommend monoclonal HET. After a first round, an e-workshop was conducted to discuss non-consensual statements, which were re-submitted for rating (Round 2). Characteristics influencing monoclonal HET initiation were evaluated. Results 31/31 experts responded to both rounds. Consensus for or against monoclonal HET was reached for 89/108 (82.4%) statements. Factors that systematically led to monoclonal HET initiation were high brain lesion load (>20 lesions), ≥2 spinal cord lesions, ≥3 gadolinium-enhancing lesions and ≥3 infratentorial lesions. A single spinal cord lesion, in combination with other factors (which, in isolation, often but not always led to monoclonal HET), systematically led to monoclonal HET recommendation. Conclusion This study suggests that the panel of French neurologists favoured monoclonal HET initiation amongst treatment-naïve RRMS patients with high radiological disease activity, whereas clinical characteristics played a complementary role.