Abstract
BackgroundDefining the transition from relapsing-remitting multiple sclerosis (RRMS) to secondary progressive multiple sclerosis (SPMS) can be challenging and delayed. A digital tool (MSProDiscuss) was developed to facilitate physician-patient discussion in evaluating early, subtle signs of multiple sclerosis (MS) disease progression representing this transition.ObjectiveThis study aimed to determine cut-off values and corresponding sensitivity and specificity for predefined scoring algorithms, with or without including Expanded Disability Status Scale (EDSS) scores, to differentiate between RRMS and SPMS patients and to evaluate psychometric properties.MethodsExperienced neurologists completed the tool for patients with confirmed RRMS or SPMS and those suspected to be transitioning to SPMS. In addition to age and EDSS score, each patient’s current disease status (disease activity, symptoms, and its impacts on daily life) was collected while completing the draft tool. Receiver operating characteristic (ROC) curves determined optimal cut-off values (sensitivity and specificity) for the classification of RRMS and SPMS.ResultsTwenty neurologists completed the draft tool for 198 patients. Mean scores for patients with RRMS (n=89), transitioning to SPMS (n=47), and SPMS (n=62) were 38.1 (SD 12.5), 55.2 (SD 11.1), and 69.6 (SD 12.0), respectively (P<.001, each between-groups comparison). Area under the ROC curve (AUC) including and excluding EDSS were for RRMS (including) AUC 0.91, 95% CI 0.87-0.95, RRMS (excluding) AUC 0.88, 95% CI 0.84-0.93, SPMS (including) AUC 0.91, 95% CI 0.86-0.95, and SPMS (excluding) AUC 0.86, 95% CI 0.81-0.91. In the algorithm with EDSS, the optimal cut-off values were ≤51.6 for RRMS patients (sensitivity=0.83; specificity=0.82) and ≥58.9 for SPMS patients (sensitivity=0.82; specificity=0.84). The optimal cut-offs without EDSS were ≤46.3 and ≥57.8 and resulted in similar high sensitivity and specificity (0.76-0.86). The draft tool showed excellent interrater reliability (intraclass correlation coefficient=.95).ConclusionsThe MSProDiscuss tool differentiated RRMS patients from SPMS patients with high sensitivity and specificity. In clinical practice, it may be a useful tool to evaluate early, subtle signs of MS disease progression indicating the evolution of RRMS to SPMS. MSProDiscuss will help assess the current level of progression in an individual patient and facilitate a more informed physician-patient discussion.
Highlights
Multiple sclerosis (MS) is the most common acquired chronic degenerative disease of the central nervous system in young adults, with more than 2.3 million people affected by the disease worldwide [1]
It may be a useful tool to evaluate early, subtle signs of multiple sclerosis (MS) disease progression indicating the evolution of relapsing-remitting multiple sclerosis (RRMS) to secondary progressive multiple sclerosis (SPMS)
With the preceding in mind, we developed MSProDiscuss, a digital tool to (1) facilitate physician-patient interaction in routine clinical practice; (2) support physicians in evaluating the early signs of progression in a structured, standardized manner based on a patient’s neurological history, the symptoms experienced, and how these affected various domains of the patient’s daily life in the past six months; and (3) help assess patient’s current level of progression
Summary
Multiple sclerosis (MS) is the most common acquired chronic degenerative disease of the central nervous system in young adults, with more than 2.3 million people affected by the disease worldwide [1]. MS evolves as a continuum with an active initial relapsing-remitting course in most patients that, generally, gradually transitions to a phase of progressive accumulation of disability with or without continued activity—relapses or new inflammatory lesions [2,3]. 50% of patients with an initial relapsing-remitting course transition to the secondary progressive phase over 15 to 20 years [4,5]. The diagnosis of secondary progressive MS (SPMS) is challenging owing to a lack of accepted clinical, imaging, immunologic, or pathologic criteria to determine when relapsing-remitting MS (RRMS) converts to SPMS [6,7,8]. Defining the transition from relapsing-remitting multiple sclerosis (RRMS) to secondary progressive multiple sclerosis (SPMS) can be challenging and delayed. A digital tool (MSProDiscuss) was developed to facilitate physician-patient discussion in evaluating early, subtle signs of multiple sclerosis (MS) disease progression representing this transition
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