Prediction of on-treatment disability worsening in RRMS with the MAGNIMS score
Amy Kunchok 1, Jeannette Lechner-Scott 2, Franco Granella 3, Maria Trojano 4, Raed Alroughani 5, Patrizia Sola 6, Diana Ferraro 6, Alessandra Lugaresi 7, Marco Onofrj 8, Serkan Ozakbas 9, Guillermo Izquierdo 10, Pierre Grammond 11, Jose Luis Sanchez-Menoyo 12, Bart Van Wijmeersch 13, Cavit Boz 14, Eugenio Pucci 15, Pamela McCombe 16, Francois Grand'Maison 17, Daniele Spitaleri 18, Steve Vucic 19, Raymond Hupperts 20, Vilija Jokubaitis 21, Maria Pia Sormani 22, Helmut Butzkueven 21, Tomas Kalincik 23; MSBase Study Group
Affiliations
Affiliations
- 1CORe, Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia/Melbourne MS Centre, Department of Neurology, The Royal Melbourne Hospital, Melbourne, VIC, Australia/The University of Sydney, Sydney, NSW, Australia/Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA.
- 2School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia/Department of Neurology, John Hunter Hospital, Hunter New England Health, Newcastle, NSW, Australia.
- 3Department of Medicine and Surgery, University of Parma, Parma, Italy/Department of Emergency and General Medicine, Parma University Hospital, Parma, Italy.
- 4Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari, Bari, Italy.
- 5Division of Neurology, Department of Medicine, Amiri Hospital, Kuwait City, Kuwait.
- 6Department of Neuroscience, Azienda Ospedaliera Universitaria, Modena, Italy.
- 7IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy/Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy.
- 8Clinica Neurologica, Department of Neuroscience, Imaging and Clinical Sciences, University of Chieti-Pescara, Chieti, Italy.
- 9Dokuz Eylul University, Konak, Turkey.
- 10Hospital Universitario Virgen Macarena, Sevilla, Spain.
- 11CISSS Chaudiere-Appalache, Levis, QC, Canada.
- 12Hospital de Galdakao-Usansolo, Galdakao, Spain.
- 13Rehabilitation and MS Centre Overpelt, Overpelt, Belgium/Hasselt University, Hasselt, Belgium.
- 14KTU Medical Faculty, Farabi Hospital, Trabzon, Turkey.
- 15UOC Neurologia, Azienda Sanitaria Unica Regionale Marche - AV3, Macerata, Italy.
- 16The University of Queensland, Brisbane, QLD, Australia/Royal Brisbane and Women's Hospital, Herston, QLD, Australia.
- 17Neuro Rive-Sud, Longueuil, QC, Canada.
- 18Azienda Ospedaliera di Rilievo Nazionale San Giuseppe Moscati Avellino, Avellino, Italy.
- 19Westmead Hospital, The University of Sydney, Sydney, NSW, Australia.
- 20Zuyderland Ziekenhuis, Sittard, The Netherlands.
- 21Central Clinical School, Monash University, Melbourne, VIC, Australia/Department of Medicine, The Alfred Hospital, Melbourne, VIC, Australia.
- 22Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.
- 23CORe, Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC, Australia/ Melbourne MS Centre, Department of Neurology, The Royal Melbourne Hospital, Melbourne, VIC, Australia.
Abstract
Background: The magnetic resonance imaging in multiple sclerosis (MAGNIMS) score combines relapses and magnetic resonance imaging (MRI) lesions to predict disability outcomes in relapsing-remitting multiple sclerosis (RRMS) treated with interferon-β.
Objective: To validate the MAGNIMS score and extend to other disease-modifying therapies (DMTs). To examine the prognostic value of gadolinium contrast-enhancing (Gd+) lesions.
Methods: This RRMS MSBase cohort study (n = 2293) used a Cox model to examine the prognostic value of relapses, MRI activity and the MAGNIMS score for disability worsening during treatment with interferon-β and three other DMTs.
Results: Three new T2 lesions (hazard ratio (HR) = 1.60, p = 0.028) or two relapses (HR = 2.24, p = 0.002) on interferon-β (for 12 months) were predictive of disability worsening over 4 years. MAGNIMS score = 2 (1 relapse and ⩾3 T2 lesions or ⩾2 relapses) was associated with a greater risk of disability worsening on interferon-β (HR = 2.0, p = 0.001). In pooled cohort of four DMTs, similar associations were seen (MAGNIMS score = 2: HR = 1.72, p = 0.001). Secondary analyses demonstrated that the addition of Gd+ to the MAGNIMS did not materially improve its prediction of disability worsening.
Conclusion: We have validated the MAGNIMS score in RRMS and extended its application to three other DMTs: 1 relapse and ⩾3 T2 lesions or ⩾2 relapses predicted worsening of disability. Contrast-enhancing lesions did not substantially improve the prognostic score.
Keywords: Multiple sclerosis; magnetic resonance imaging; outcomes; prediction; prognosis; therapy.
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