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Table 1 MAGNIMS consensus guideline: regimens for risk-based MRI monitoring in MS patients treated with natalizumab [24]

From: Design of TRUST, a non-interventional, multicenter, 3-year prospective study investigating an integrated patient management approach in patients with relapsing-remitting multiple sclerosis treated with natalizumab

Population Recommended MRI regimen Interval
Natalizumab-treated patients
at high risk of PML (ie, anti-JCV seropositive AND treatment duration ≥18 months)
• Conventional T2-weighted imaging
• T2-FLAIR
• DWI
• Contrast-enhanced T1-weighted imaging [in patients with suspected PML lesions]
• Every 3–4 months
Natalizumab-treated patients at low risk of PML (i.e., anti-JCV seronegative) • Conventional T2-weighted imaging
• T2-FLAIR
• DWI
• Every 12 months
Patients who switch from natalizumab to other drugs (including fingolimod, alemtuzumab, dimethyl fumarate) • Conventional T2-weighted imaging
• Contrast-enhanced T1-weighted imaging
• Every 3–4 months, for up to 12 months
Patients at high risk of developing opportunistic infections who are switching immunotherapies • Conventional T2-weighted Imaging
• Contrast-enhanced T1-weighted imaging
• T2-FLAIR
• DWI
• Contrast-enhanced T1-weighted imaging [in patients with suspected PML lesions]
• At end of ongoing therapy
• After starting therapy with the next drug
  1. DWI diffusion-weighted imaging, FLAIR fluid-attenuated inversion recovery