BACKGROUND: The MSBase prediction model of treatment response leverages multiple demographic and clinical characteristics to estimate hazards of relapses, confirmed disability accumulation (CDA), and confirmed disability improvement (CDI). The model did not include Multiple Sclerosis Severity Score (MSSS), a disease duration-adjusted ranked score of disability. OBJECTIVE: To incorporate MSSS into the MSBase prediction model and compare model accuracy with and without MSSS. METHODS: The associations between MSSS and relapse, CDA, and CDI were evaluated with marginal proportional hazards models adjusted for three principal components representative of patients' demographic and clinical characteristics. The model fit with and without MSSS was assessed with penalized r2 and Harrell C. RESULTS: A total of 5866 MS patients were started on disease-modifying therapy during prospective follow-up (age 38.4 ± 10.6 years; 72% female; disease duration 8.5 ± 7.7 years). Including MSSS into the model improved the accuracy of individual prediction of relapses by 31%, of CDA by 23%, and of CDI by 24% (Harrell C) and increased the amount of variance explained for relapses by 49%, for CDI by 11%, and for CDA by 10% as compared with the original model. CONCLUSION: Addition of a single, readily available metric, MSSS, to the comprehensive MSBase prediction model considerably improved the individual accuracy of prognostics in MS.

Azienda Ospedaliera di Rilievo Nazionale San Giuseppe Moscati Avellino Avellino Italy

Bakirkoy Education and Research Hospital for Psychiatric and Neurological Diseases Istanbul Turkey

Central Clinical School Monash University Melbourne VIC Australia

CISSS Chaudi're Appalache Levis QC Canada

Cliniques Universitaires Saint Luc UCLouvain Brussels Belgium

CORe Department of Medicine The University of Melbourne Melbourne VIC Australia MS Centre Department of Neurology The Royal Melbourne Hospital Melbourne VIC Australia

CSSS Saint Jérôme Saint Jerome QC Canada

Department of Biostatistics UAB School of Public Health Birmingham AL USA

Department of Medicine and Surgery University of Parma Parma Italy

Department of Neurology Charles University Prague Prague Czech Republic

Department of Neurology Zuyderland Medical Centre Sittard Geleen The Netherlands School for Mental Health and Neuroscience Department of Neurology Maastricht University Medical Centre Maastricht The Netherlands

Department of Neuroscience Imaging and Clinical Sciences University G d'Annunzio Chieti Italy

Division of Neurology Department of Medicine Amiri Hospital Sharq Kuwait

Dokuz Eylul University Izmir Turkey

GF Ingrassia Department University of Catania Catania Italy

Haydarpasa Numune Training and Research Hospital Istanbul Turkey

Hospital S João Porto Portugal; University Fernando Pessoa Porto Portugal

Hospital Universitario Virgen Macarena Sevilla Spain

IRCCS Istituto delle Scienze Neurologiche di Bologna Bologna Italy Dipartimento di Scienze Biomediche e Neuromotorie Università di Bologna Bologna Italy

IRCCS Mondino Foundation Pavia Italy

Isfahan University of Medical Sciences Isfahan Islamic Republic of Iran

KTU Medical Faculty Farabi Hospital Trabzon Turkey

Medical Faculty 19 Mayis University Samsun Turkey

Nemocnice Jihlava Jihlava Czech Republic

Neuro Rive Sud Greenfield Park QC Canada

Neurology NYU School of Medicine New York NY USA

Neurology Unit Department of Neuroscience Azienda Ospedaliera Universitaria Modena Italy

Neurology Unit Department of Neuroscience Azienda Ospedaliera Universitaria Modena Italy Department of Biomedical Metabolic and Neurosciences University of Modena and Reggio Emilia Modena Italy

Neurology Unit Piazza S Maria di Gesù 5 Catania Italy

Ospedali Riuniti di Salerno Salerno Italy

Research Center for Clinical Neuroimmunology and Neuroscience and MS Center Departments of Head Spine and Neuromedicine Clinical Research and Biomedicine University Hospital Basel University of Basel Basel Switzerland

School of Medicine and Public Health The University of Newcastle Newcastle NSW Australia

Universite de Montreal and CHUM Montreal QC Canada

UOC Neurologia Azienda Sanitaria Unica Regionale Marche AV3 Macerata Italy

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