Combined measures of clinical and radiological activity integrated into different scores—such as the Rio score, modified Rio score, magnetic resonance imaging (MRI) in multiple sclerosis (MS) score, and risk of ambulatory disability score—during the first year of treatment with disease-modifying therapies can help identify MS patients at risk of long-term disability. This is according to a new study published in the Journal of Neurology

The study also showed that scores that included early worsening on the Expanded Disability Status Scale (EDSS) score in the first year of treatment could better differentiate patients with a greater risk of worsening disability. 

“Thus, these data reinforce the concept of early treatment optimization to minimize the risk of long-term disability,” first author Jordi Río, PhD, and the coauthors of the study wrote. 

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MS is a progressive disease characterized by worsening symptoms and disability. There now exist several disease-modifying therapies that can delay the progression of the disease and reduce the number of relapses a patient has. 

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A number of scoring systems can measure patients’ responses to these treatments. In the present study, a team of researchers led by Xavier Montalban, MD, PhD, sought to assess the ability of these scoring systems to predict disability in the long term.

They collected brain MRI data from 319 patients with relapsing-remitting MS who were being treated with disease-modifying treatments before the start of treatment and 1 year later. The patients had neurological assessments every 6 months. 

The results showed that patients who had a Rio score of more than 1 and a risk of ambulatory disability score of more than 3 had a higher risk of reaching an EDSS score of 4 and 6, respectively.

The ambulatory disability score had the best sensitivity, and the modified Rio score had the best specificity. The score with the best positive predictive value and accuracy was the Rio score.

The researchers concluded, “The combined measures integrated into different scores have an acceptable prognostic value for identifying patients with long-term disability.”


Río J, Rovira À, Gasperini C, et al. Treatment response scoring systems to assess long-term prognosis in self-injectable DMTs relapsing-remitting multiple sclerosis patients. J Neurol. Published online October 1, 2021. doi:10.1007/s00415-021-10823-z