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Peer-reviewedCC BYJournal of neurology

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

  • Bertrand Bourre1
  • Olivier Guerrier2
  • Xavier Ayrignac3
  • Laurent Suchet4
  • Jérôme de Seze5
  • Ines Masmoudi6
  • Vito A G Ricigliano7,8
  • Patrick Vermersch9
  • Jonathan Ciron10,11
  • CAReSEP working group
11 affiliations
  1. 1Department of Neurology and Inserm, CIC-CRB 1404, CHU Rouen, F-76000, Rouen, France.
  2. 2Department of Neurology and Neurovascular Unit, Valence Hospital, Valence, France.
  3. 3Département de Neurologie, CRC sclérose en plaques, CRMR LEUKOFRANCE & Centre d'investigation clinique U1411, CHU de Montpellier, INM, INSERM, Univ Montpellier, Montpellier, France.
  4. 4Department of Neurology, European Hospital of Marseille, Marseille, France.
  5. 5Department of Neurology and Clinical Investigation Center, Strasbourg University Hospital, Strasbourg, France.
  6. 6Department of Neurology, Amiens University Hospital, Amiens, France.
  7. 7Neurology Unit, GHNE Paris Saclay Hospital, Orsay, France.
  8. 8UNIACT, Neurospin-INSERM UMR 1129, CEA, Université Paris-Saclay, Gif-sur-Yvette, France.
  9. 9INSERM U1172 LilNCog, Lille University Hospital, FHU Precise, University of Lille, Lille, France.
  10. 10Department of Neurology, CRC-SEP, Toulouse University Hospital, Toulouse, France. [email protected].
  11. 11INSERM UMR1291-CNRS UMR5051, INFINITY, University Toulouse III, Toulouse, France. [email protected].
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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.

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Cite

BibTeXRIS
BibTeX
@article{bourre2026delphi,
  title = {{DELPHI expert consensus-derived factors influencing the early use of monoclonal high-efficacy therapies in treatment-naïve patients with relapsing-remitting multiple sclerosis.}},
  author = {Bertrand Bourre and Olivier Guerrier and Xavier Ayrignac and Laurent Suchet and Jérôme de Seze and Ines Masmoudi and Vito A G Ricigliano and Patrick Vermersch and Jonathan Ciron and CAReSEP working group},
  journal = {Journal of neurology},
  year = {2026},
  month = oct,
  doi = {10.1007/s00415-026-14167-4},
  url = {https://europepmc.org/article/MED/42911241},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - DELPHI expert consensus-derived factors influencing the early use of monoclonal high-efficacy therapies in treatment-naïve patients with relapsing-remitting multiple sclerosis.
AU  - Bertrand Bourre
AU  - Olivier Guerrier
AU  - Xavier Ayrignac
AU  - Laurent Suchet
AU  - Jérôme de Seze
AU  - Ines Masmoudi
AU  - Vito A G Ricigliano
AU  - Patrick Vermersch
AU  - Jonathan Ciron
AU  - CAReSEP working group
PY  - 2026
DA  - 2026/10/22
JO  - Journal of neurology
DO  - 10.1007/s00415-026-14167-4
UR  - https://europepmc.org/article/MED/42911241
AB  - 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.
SN  - 0340-5354
SN  - 1432-1459
ER  -