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Multicenter Study
. 2021 Feb;268(2):669-679.
doi: 10.1007/s00415-020-10154-5. Epub 2020 Sep 9.

SMILE: a predictive model for Scoring the severity of relapses in MultIple scLErosis

F Lejeune  1   2 , A Chatton  3 , D-A Laplaud  1   2 , E Le Page  4 , S Wiertlewski  1   2 , G Edan  4 , A Kerbrat  4 , D Veillard  5 , S Hamonic  5 , N Jousset  6 , F Le Frère  6 , J-C Ouallet  7 , B Brochet  7 , A Ruet  7 , Y Foucher  3   8 , Laure Michel  9   10   11
Affiliations
Multicenter Study

SMILE: a predictive model for Scoring the severity of relapses in MultIple scLErosis

F Lejeune et al. J Neurol. 2021 Feb.

Abstract

Background: In relapsing-remitting multiple sclerosis (RRMS), relapse severity and residual disability are difficult to predict. Nevertheless, this information is crucial both for guiding relapse treatment strategies and for informing patients.

Objective: We, therefore, developed and validated a clinical-based model for predicting the risk of residual disability at 6 months post-relapse in MS.

Methods: We used the data of 186 patients with RRMS collected during the COPOUSEP multicentre trial. The outcome was an increase of ≥ 1 EDSS point 6 months post-relapse treatment. We used logistic regression with LASSO penalization to construct the model, and bootstrap cross-validation to internally validate it. The model was externally validated with an independent retrospective French single-centre cohort of 175 patients.

Results: The predictive factors contained in the model were age > 40 years, shorter disease duration, EDSS increase ≥ 1.5 points at time of relapse, EDSS = 0 before relapse, proprioceptive ataxia, and absence of subjective sensory disorders. Discriminative accuracy was acceptable in both the internal (AUC 0.82, 95% CI [0.73, 0.91]) and external (AUC 0.71, 95% CI [0.62, 0.80]) validations.

Conclusion: The predictive model we developed should prove useful for adapting therapeutic strategy of relapse and follow-up to individual patients.

Keywords: EDSS; Multiple sclerosis; Predictive model; Relapse phenotype; Relapse recovery.

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