BACKGROUND: Secondary progressive MS is associated with a worse prognosis, warranting the need for early predictive tools. The DAAE score estimates the five-year risk of transition to clinical diagnosis of SPMS, showing a 38 % risk in high-risk patients in Amsterdam and Buffalo data. The DAAE score remains to be validated against objective disease progression criteria. METHODS: External validation using data from the Prague MS cohort and MSBase-Lorscheider criteria. RESULTS: Among 2022 patients from the Prague MS database, 14.3 % clinically progressed according to MSbase-Lorscheider criteria over five years. Risk increased with higher DAAE scores comparable to the Amsterdam and Buffalo data; secondary validation showed an AUROC of 0.742 with faster progression for higher risk groups (p < 0.05), therapy-adjusted. CONCLUSION: The DAAE score performs similarly between centers and using objective criteria. These validation steps support its use in personalized MS management and treatment.

Department of Neurology 1st Faculty of Medicine Charles University and General University Hospital Prague Prague Czech Republic

MS Center Amsterdam Department of Anatomy and Neurosciences Vrije Universiteit Amsterdam Amsterdam Neuroscience Amsterdam UMC location VUmc Amsterdam the Netherlands

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