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. 2025 Jul:99:106453.
doi: 10.1016/j.msard.2025.106453. Epub 2025 Apr 17.

Determination of disability progression in moderately and highly disabled ambulatory patients with relapsing-remitting multiple sclerosis using the EDSS-Plus: A prospective study in Argentina

Ricardo Alonso  1 , Maria Barbara Eizaguirre  2 , Magdalena Casas  2 , Luciana Lazaro  2 , Alfredo Laffue  3 , Carolina Mainella  4 , Dario Tavolini  5 , Felisa Leguizamon  6 , Gustavo Jose  7 , Juan Ignacio Rojas  8 , Marcos Burgos  9 , Norma Deri  10 , Susana Liwacki  11 , Veronica Tkachuk  12 , Berenice Silva  13
Affiliations

Determination of disability progression in moderately and highly disabled ambulatory patients with relapsing-remitting multiple sclerosis using the EDSS-Plus: A prospective study in Argentina

Ricardo Alonso et al. Mult Scler Relat Disord. 2025 Jul.

Abstract

Background: Multiple Sclerosis (MS) is a chronic autoimmune disease causing central nervous system damage. Relapsing-remitting MS (RRMS) is the most common type. Disability in MS can result from relapse-associated worsening (RAW) or progression independent of relapse activity (PIRA), impacting quality of life. The Expanded Disability Status Scale (EDSS) is commonly used but has limitations. The Multiple Sclerosis Functional Composite (MSFC) improves progression detection sensitivity.

Objective: To analyze disability progression in a subgroup of RRMS patients (EDSS 3.0-6.5) and compare EDSS-Plus (EDSS, T25FW, and 9HPT) and EDSS-Plus with cognition (EDSS-Plus cog) to EDSS in assessing disease progression.

Methodology: An 18-month prospective study in Argentina involved RRMS patients meeting the 2017 McDonald criteria and an EDSS between 3.0 and 6.5 at baseline. Patients received standard care and were assessed using EDSS, T25FW, 9HPT, and SDMT. Progression was defined as a ≥ 1.0-point increase in EDSS (baseline ≤5.5) or ≥0.5-point increase (baseline ≥6.0) over 24 weeks.

Results: EDSS-Plus and EDSS-Plus cog identified more progressors than EDSS, especially in patients with higher baseline disability (EDSS >4). Progression rates were 14 % for EDSS, 22.17 % for EDSS-Plus, and 25.33 % for EDSS-Plus cog. Progressors showed higher fatigue, depression, and anxiety scores.

Conclusion: EDSS-Plus and EDSS-Plus cog are more sensitive than EDSS in detecting disability progression in RRMS patients, particularly those with higher baseline disability. However, this increase in detected progression events reflects the broader assessment criteria rather than necessarily indicating greater accuracy in identifying true disease progression.

Keywords: Disability; Disease progression; Expanded disability status scale; Multiple sclerosis.

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Conflict of interest statement

Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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