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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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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 (&gt;20 lesions), \u22652 spinal cord lesions, \u22653 gadolinium-enhancing lesions and \u22653 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study suggests that the panel of French neurologists favoured monoclonal HET initiation amongst treatment-na\u00efve RRMS patients with high radiological disease activity, whereas clinical characteristics played a complementary role.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00415-026-14167-4","type":"journal-article","created":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T07:42:38Z","timestamp":1792654958000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["DELPHI expert consensus-derived factors influencing the early use of monoclonal high-efficacy therapies in treatment-na\u00efve patients with relapsing-remitting multiple sclerosis"],"prefix":"10.1007","volume":"273","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2459-2480","authenticated-orcid":false,"given":"Bertrand","family":"Bourre","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-0311-3981","authenticated-orcid":false,"given":"Olivier","family":"Guerrier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3834-2981","authenticated-orcid":false,"given":"Xavier","family":"Ayrignac","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3189-2315","authenticated-orcid":false,"given":"Laurent","family":"Suchet","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7197-7578","authenticated-orcid":false,"given":"J\u00e9r\u00f4me","family":"de Seze","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-6959-3648","authenticated-orcid":false,"given":"Ines","family":"Masmoudi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8860-3548","authenticated-orcid":false,"given":"Vito A. 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OG has received personal\/consulting\/advisory board or investigator fees from Novartis, Merck, Roche, Sanofi, Biogen, Janssen and Alexion Pharmaceuticals. XA has received consulting and lecturing fees, travel grants, and unconditional research support from Alexion, Biogen, Genzyme, Janssen, Novartis, Merck Serono, Roche, and Teva Pharmaceuticals. LS has received consulting\/advisory board\/investigator fees or funding for travel from Adelia, Angelini, Biogen, Lundbeck, Merck, Novartis, Orkyn, Roche, Sanofi. JdS has received consulting\/advisory board\/scientific meeting fees from Abbvie, Amgen, Argenx, Alexion\/Astra Zeneca, Biogen, CSL Behring, Juvis\u00e9, Janssen, LFB, Merck, Neuraxpharm, Novartis, Sanofi, Sandoz, Roche and Pfizer. IS has received consulting\/advisory board\/investigator fees or funding for travel from Biogen, Horizon Therapeutics, Janssen, Merck, Merz, Novartis, Roche, Sandoz and Sanofi. VAR has received personal\/consulting\/advisory board fees from Amgen, Novartis, Merck, Roche, Sanofi, Sandoz, Biogen, Janssen, M3 Global Research, Atheneum Partners, and unconditional research support from Roche and Juvis\u00e9. PV has received honorarium, contributions to meetings from Biogen, Sanofi-Genzyme, Novartis, Merck, Roche, AB Science, Janssen, Ad Scientiam and Juvis\u00e9. He has received research supports from Novartis, Sanofi-Genzyme and Merck. 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