Using Personalized Prognosis in the Treatment of Relapsing Multiple Sclerosis: A Practical Guide

Authors: Bart Van Wijmeersch¹, Hans-Peter Hartung², Patrick Vermersch³, Maura Pugliatti⁴, Carlo Pozzilli⁵, Nikolaos Grigoriadis⁶, Mona Alkhawajah⁷, Laura Airas⁸, Ralf Linker⁹, and Celia Oreja-Guevara¹⁰

1) University MS Centre, Belgium; Noorderhart, Rehabilitation and MS, Pelt, Belgium; University of Hasselt, Belgium 2) Department of Neurology, Faculty of Medicine, Heinrich Heine University, Germany; Brain and Mind Centre, The University of Sydney, Australia; Medical University Vienna, Austria; Palacký University, Olomouc, Czechia 3) Univ. Lille, Inserm U1172 LilNCog, CHU Lille, FHU Precise, France 4) Department of Neuroscience and Rehabilitation, University Hospital of Ferrara, Italy; Unit of Clinical Neurology, S. Anna University Hospital, Italy 5) Dept Human Neuroscience, Sapienza University, Italy 6) B’ Dept of Neurology, Aristotle University of Thessaloniki, Greece 7) King Faisal Specialist Hospital & Research Centre, Saudi Arabia 8) Turku University Hospital and University of Turku, Finland 9) Department of Neurology, University Hospital Regensburg, Germany 10) Department of Neurology, Hospital Clínico San Carlos, IDISSC, Spain; Department of Medicine, Faculty of Medicine, Universidad Complutense de Madrid, Spain

Abstract

The clinical course of multiple sclerosis (MS) is highly variable among patients, thus creating important challenges for the neurologist to appropriately treat and monitor patient progress. Despite some patients having apparently similar symptom severity at MS disease onset, their prognoses may differ greatly. To this end, we believe that a proactive disposition on the part of the neurologist to identify prognostic “red flags” early in the disease course can lead to much better long-term outcomes for the patient in terms of reduced disability and improved quality of life. Here, we present a prognosis tool in the form of a checklist of clinical, imaging and biomarker parameters which, based on consensus in the literature and on our own clinical experiences, we have established to be associated with poorer or improved clinical outcomes. The neurologist is encouraged to use this tool to identify the presence or absence of specific variables in individual patients at disease onset and thereby implement sufficiently effective treatment strategies that appropriately address the likely prognosis for each patient.

This article was published in the scientific journal Frontiers in Immunology, Section Multiple Sclerosis and Neuroimmunology on the 27 September 2022.

Prognosis tool

With this tool we aim to provide neurologists with a practical ‘checklist’ guide to establishing the likely prognosis of patients based primarily on baseline clinical parameters that can also be reassessed at periodic follow-up visits. The guide will allow neurologists to identify ‘red flag’ parameters in the MS patient profile that are related to poorer long-term prognosis.

This MS prognosis tool brings together a considerable amount of data specific to each MS patient, thereby providing the MS neurologist with a comprehensive overview of each patient’s current and potential disease status in the future. The tool also should facilitate the development of personalised treatment approaches based on individualised prognostic evidence, enabling outcomes for MS patients to be optimised.

Flyer

Next steps!

We are working to upgrade this checklist into an online tool that HCPs will be able to fill in on their computer. An algorithm will support users weighting the different criteria proposed allowing increased precision in the final results. This is part of a PhD project that will be rolled out on a span of 4 years. Stay tuned for more information!

Author contributions

Development of the tool was led by Bart Van Wijmeersch, with input from all other authors at regular meetings. Bart Van Wijmeersch wrote the manuscript, with feedback on early versions provided by Hans-Peter Hartung, and Celia Oreja-Guevara.

All authors contributed to manuscript revision and read and approved the submitted version.

Funding

Medical writing support for the preparation of this manuscript along with the payment of publishing fees were provided by the ParadigMS Foundation.

Acknowledgments

The creation and communication of educational materials by the ParadigMS Foundation is sponsored by Sanofi, Roche, and Merck.

The dissemination activities linked to the prognosis tool itself are funded by a grant of Sanofi Belgium.

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher’s note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

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©The table (prognosis tool) contains the same content as that in the published paper (available at the Frontiers of Immunology website) and distributed under the Creative Commons license agreement.