Towards a validated definition of the clinical transition to secondary progressive multiple sclerosis: A study from the Italian MS Register. (December 2022)

• Record Type: Journal Article
• Authors: Iaffaldano, Pietro; Lucisano, Giuseppe; Guerra, Tommaso; Patti, Francesco; Onofrj, Marco; Brescia Morra, Vincenzo; Zaffaroni, Mauro; Pozzilli, Carlo; Cocco, Eleonora; Sola, Patrizia; Salemi, Giuseppe; Inglese, Matilde; Bergamaschi, Roberto; Gasperini, Claudio; Conte, Antonella; Salvetti, Marco; Lus, Giacomo; Maniscalco, Giorgia Teresa; Totaro, Rocco; Vianello, Marika; Granella, Franco; Ferraro, Elisabetta; Aguglia, Umberto; Gatto, Maurizia; Sangalli, Francesca; Chisari, Clara Grazia; De Luca, Giovanna; Carotenuto, Antonio; Baroncini, Damiano; Colombo, Delia; Nica, Mihaela; Paolicelli, Damiano; Comi, Giancarlo; Filippi, Massimo; Amato, Maria Pia; Trojano, Maria;
• Is Part Of: Multiple sclerosis. Volume 28:Number 14(2022)
• Page Start: 2243
• Page End: 2252
• Publication Date: 2022-12
• Subjects: Multiple sclerosis -- secondary progressive -- disease registry -- big data -- prognosis -- data-driven algorithm; Central nervous system -- Diseases -- Periodicals; Myelin sheath -- Diseases -- Periodicals; Inflammation -- Periodicals; Multiple sclerosis -- Periodicals; Central Nervous System Diseases -- Periodicals; Demyelinating Diseases -- Periodicals; Inflammation -- Periodicals; Multiple Sclerosis -- Periodicals; Système nerveux central -- Maladies -- Périodiques; Gaine de myéline -- Maladies -- Périodiques; Inflammation (Pathologie) -- Périodiques; Sclérose en plaques -- Périodiques; Electronic journals; 616.834005
• DOI: 10.1177/13524585221114007
• Languages: English
• ISSNs: 1352-4585

Abstract

Background: Definitions for reliable identification of transition from relapsing-remitting multiple sclerosis (MS) to secondary progressive (SP)MS in clinical cohorts are not available. Objectives: To compare diagnostic performances of two different data-driven SPMS definitions. Methods: Data-driven SPMS definitions based on a version of Lorscheider's algorithm (DDA) and on the EXPAND trial inclusion criteria were compared, using the neurologist's definition (ND) as gold standard, in terms of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), Akaike information criterion (AIC) and area under the curve (AUC). Results: A cohort of 10, 240 MS patients with ⩾5 years of follow-up was extracted from the Italian MS Registry; 880 (8.5%) patients were classified as SPMS according to the neurologist definition, 1806 (17.6%) applying the DDA and 1134 (11.0%) with the EXPAND definition. The DDA showed greater discrimination power (AUC: 0.8 vs 0.6) and a higher sensitivity (77.1% vs 38.0%) than the EXPAND definition, with similar specificity (88.0% vs 91.5%). PPV and NPV were higher using the DDA than considering EXPAND definition (37.5% vs 29.5%; 97.6% vs 94.0%). Conclusion: Data-driven definitions demonstrated greater ability to capture SP transition than neurologist's definition and the global accuracy of DDA seems to be higher than the EXPAND definition.