Multiple sclerosis (MS) is a common cause of severe neurological disability in young adults, resulting from an autoimmune interruption of both myelin and axons within the central nervous system (CNS). The diagnosis is made by fulfilling both spatial criteria, by meeting the requisite number of lesions within the brain or spinal cord, along with criteria for time, by demonstrating a history of at least a second clinical attack or the development of a new MS lesion on MRI after the seminal neurological event. In the case of MS, healthy individuals who do not exhibit signs of neurological dysfunction commonly have brain MRI studies performed for a reason other than an evaluation for MS that reveal unexpected anomalies highly suggestive of demyelinating plaques given their size, location, and morphology. These healthy subjects lack symptomatology suggestive of MS and fulfill formal criteria for radiologically isolated syndrome (RIS), a recently described MS subtype that expands upon the phenotype of at-risk individuals for future demyelinating events. The discovery of such anomalies creates intersecting neuro-ethical, legal, social, and practical medical management quandaries and is, therefore, of both immediate and long-term clinical significance. Despite advancements in the characterization of RIS subjects, and in our understanding of risk factors for initial symptom development, the effect of treatment on such cases remain unclear. The purpose of this investigation is to systematically study the efficacy of Teriflunomide in those individuals who possess incidental white matter anomalies within the brain and following a MRI study that is performed for a reason other than for the evaluation of MS. RIS subjects are frequently exposed to disease modifying therapies despite the lack of scientific literature supporting the use of such treatments. Earlier treatment intervention may extend the time to the first acute or progressive clinical event resulting from CNS demyelination and reduce radiological progression. In addition, early treatment may result in more profound effects on reducing disability progression long-term. The primary outcome measure for this trial is the time to the first acute or progressive neurological event resulting from CNS demyelination. This study will include RIS subjects from the Europe who fulfill 2009 RIS Criteria.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
125
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CHU de Bordeaux
Bordeaux, France
CHU de Caen
Caen, France
CHU de Clermont-Ferrand
Clermont-Ferrand, France
CHU de Grenoble
Grenoble, France
CHRU de Lille
Lille, France
Hospices Civils de Lyon
Lyon, France
CHRU de Montpellier
Montpellier, France
CHU de Nantes
Nantes, France
CHU de Nice
Nice, France
CHU de Nîmes
Nîmes, France
...and 13 more locations
Time to the first acute or progressive neurological event resulting from CNS demyelination.
Acute neurological event: The development of an acute neurological episode localized to the optic nerve, brainstem, cerebellum, spinal cord, or long sensory or motor tracts, lasting \> 24 hours followed by a period of symptom improvement. Progressive event: The onset of a clinical symptom (e.g. leg weakness) with the temporal profile revealing at least a 12-month progression of neurological deficits.
Time frame: Week 96
New or enlarging T2 lesions
Number of new or enlarging T2 lesions on MRI
Time frame: Week 48
New or enlarging T2 lesions
Number of new or enlarging T2 lesions on MRI
Time frame: Week 96
New contrast enhancing lesions
New contrast enhancing lesions on MRI
Time frame: Week 48
New contrast enhancing lesions
New contrast enhancing lesions on MRI
Time frame: Week 96
New T2-lesion volumes
New T2-lesion volumes on MRI
Time frame: Week 48
New T2-lesion volumes
New T2-lesion volumes on MRI
Time frame: Week 96
Brain atrophy
Brain atrophy on MRI
Time frame: Week 96
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