Prediction of on-treatment disability worsening in RRMS with the MAGNIMS score

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-beta. 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-beta 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-beta (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-beta (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.