Scoring the 10-year risk of ambulatory disability in multiple sclerosis: the RoAD score

Background and purpose Both baseline prognostic factors and short-term predictors of treatment response can influence the long-term risk of disability accumulation in patients with relapsing-remitting multiple sclerosis (RRMS). The objective was to develop and validate a scoring system combining baseline prognostic factors and 1-year variables of treatment response into a single numeric score predicting the long-term risk of disability. Methods We analysed two independent datasets of patients with RRMS who started interferon beta or glatiramer acetate, had an Expanded Disability Status Scale (EDSS) score <4.0 at treatment start and were followed for at least 10 years. The first dataset ('training set') included patients attending three MS centres in Italy and served as a framework to create the so-called RoAD score (Risk of Ambulatory Disability). The second ('validation set') included a cohort of patients followed in Barcelona, Spain, to explore the performance of the RoAD score in predicting the risk of reaching an EDSS score >= 6.0. Results The RoAD score (ranging from 0 to 8) derived from the training set (n = 1225), was based on demographic (age), clinical baseline prognostic factors (disease duration, EDSS) and 1-year predictors of treatment response (number of relapses, presence of gadolinium enhancement and new T2 lesions). The best cut-off score for discriminating patients at higher risk of reaching the disability milestone was >= 4. When applied to the validation set (n = 296), patients with a RoAD score >= 4 had an approximately 4-fold increased risk for reaching the disability milestone (p < 0.001). Discussion The RoAD score is proposed as an useful tool to predict individual prognosis and optimize treatment strategy of patients with RRMS.

Automated summary

The study aimed to develop and validate a scoring system combining baseline prognostic factors and 1-year variables of treatment response to predict the long-term risk of disability accumulation in patients with RRMS. The RoAD score showed to be a useful tool in predicting the risk of reaching a disability milestone and optimizing treatment strategy for RRMS patients.