A novel score can identify patients at risk for secondary progressive MS

According to study results published in the European Journal of Neurology, the Secondary Progressive Risk Score (SP-RiSc) can help identify patients at an increased risk of switching from relapsing-remitting to secondary phase multiple sclerosis (MS) .

With limited data on the value of various traits in predicting the risk of transition from relapsing-remitting MS to the secondary progressive phase, the aim of the current study was to determine the role of SP-RiSc, using demographic, clinical, and MRI data integrated collected in the first 2 years after the diagnosis of the disease to predict the risk for the secondary progressive phase.

The sample included 262 patients with relapsing-remitting MS from 2005-2010 through 2018 from the MS Specialist Center at the University of Verona, Italy. Study researchers assessed the likelihood of developing a secondary progressive course using clinical and imaging data at diagnosis and after the first 2 years of disease progression. They combined the most predictive factors associated with secondary progressive conversion risk to create the SP-RiSc tool.

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The participants were randomly divided into a training set (219 participants) and a test set (43 participants). During the 10-year follow-up period, 69 (26%) patients were switched to secondary progressive MS.

Using Random Survival Forest, a machine learning approach, the researchers identified 7 variables that highly predict the risk of switching to secondary progressive MS, including global cortical thinning (minimum depth) [MD], 1.65), loss of cerebellar cortical volume (MD, 2.15), stress on cortical lesions at diagnosis (MD, 2.47) and their increase after 2 years (MD, 3.15), age (MD, 3.30), expanded scale for disability status (MD, 3.30). 4.10) and the total number of white matter lesions in the diagnosis of recurrent remitting MS (MD, 4.17).

Using Ensemble Mortality, the study researchers identified three risk groups: high, medium and low risk.

In the high-risk group, 46 of 55 patients (85.5%) switched to the secondary progressive phase during the follow-up period (median interval 7 years), while in the middle group only 9 (17.7%) patients switched to the secondary progressive phase (median interval 8.5 years). All patients in the low-risk group remained in the relapsing remission phase throughout the study period.

The probability of going into the secondary progressive phase within 10 years of diagnosis was 92% with an SP-RiSc of at least 17.7, while patients with SP-RiSc less than 17.7 had an 87% probability of stay in the relapsing remission phase.

The study had several limitations, including the subjective definition of clinical onset of the progressive phase, the lack of data on onset symptoms in the study model, and the relatively small sample size.

“The SP-RiSc performed well in identifying MS patients with a high likelihood of developing SPMS [secondary progressive MS]that can help improve management strategies. These results are the prerequisite for further larger prospective studies to evaluate the use in clinical settings, ”concluded the study researchers.

Disclosure: Several authors of the study have stated that they are part of the pharmaceutical industry. For a full list of the authors’ information, see the original reference.


Pisani AI, Scalfari A, Crescenzo F, Romualdi C, Calabrese M. A novel prognostic score for assessing the risk of progression in patients with recurrent multiple sclerosis. Eur J Neurol. Published online April 9, 2021. doi: 10.1111 / ene.14859

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