The Barcelona baseline risk score to predict long-term prognosis after a first demyelinating event: a prospective observational studyResearch in context
Summary: Background: In multiple sclerosis (MS), predicting at symptom onset who will develop early and severe disability is an unmet need with significant therapeutic implications. Here we propose the Barcelona-Baseline Risk Score (BRS) model to predict long-term disease outcomes in a flexible and...
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2025-06-01
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| Series: | The Lancet Regional Health. Europe |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666776225000948 |
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| author | Carmen Tur Pere Carbonell-Mirabent Susana Otero-Romero Álvaro Cobo-Calvo María Jesús Arévalo Helena Ariño Georgina Arrambide Cristina Auger René Carvajal Joaquín Castilló Manuel Comabella Ingrid Galán Luciana Midaglia Carlos Nos Agustín Pappolla Deborah Pareto Jordi Río Breogán Rodríguez-Acevedo Estibaliz Saez de Gordoa Ángela Vidal-Jordana Ana Zabalza Jaume Sastre-Garriga Àlex Rovira Xavier Montalban Mar Tintoré |
| author_facet | Carmen Tur Pere Carbonell-Mirabent Susana Otero-Romero Álvaro Cobo-Calvo María Jesús Arévalo Helena Ariño Georgina Arrambide Cristina Auger René Carvajal Joaquín Castilló Manuel Comabella Ingrid Galán Luciana Midaglia Carlos Nos Agustín Pappolla Deborah Pareto Jordi Río Breogán Rodríguez-Acevedo Estibaliz Saez de Gordoa Ángela Vidal-Jordana Ana Zabalza Jaume Sastre-Garriga Àlex Rovira Xavier Montalban Mar Tintoré |
| author_sort | Carmen Tur |
| collection | DOAJ |
| description | Summary: Background: In multiple sclerosis (MS), predicting at symptom onset who will develop early and severe disability is an unmet need with significant therapeutic implications. Here we propose the Barcelona-Baseline Risk Score (BRS) model to predict long-term disease outcomes in a flexible and generalisable manner. Methods: Using prospectively acquired data from the Barcelona first-attack cohort, we created the Barcelona-BRS model as a set of six Weibull survival models of time to an Expanded Disability Status Scale score of 3.0, built with flexible combinations of predictors, including sex, age at first attack, and number and topography of T2 lesions, among others, adaptable to data availability. Data-driven risk groups were identified and compared in terms of long-term clinical and MRI outcomes, including relapse-associated worsening (RAW), progression independent of relapse activity (PIRA), conversion to secondary progressive MS (SPMS), lesional and brain volumetric data, and patient-reported/administered clinical scores, through Kaplan–Meier and mixed-effects models. Finally, we externally validated our model in a completely unseen cohort. Findings: We included 1074 patients (737 [69%] female, mean age: 31.7 years) with a first demyelinating attack. Over a median follow-up of 11.9 years, 375 (35%), 298 (28%), and 94 (8.8%) developed RAW, PIRA, and SPMS, respectively. Weibull models included age at first attack, number of brain T2 lesions, and disability at first visit as main predictors. Four data-driven groups of increasing risk of unfavourable outcomes were created: Light-Green-BRS (N = 258), Dark-Green-BRS (N = 319), Orange-BRS (N = 321), and Red-BRS (N = 176), which, over time, behaved significantly differently across disability, quality of life, and MRI measures, being the Red-BRS the group with worst outcomes (p < 0.01). The results in the external validation cohort (N = 139, 100 female [72%], 34 years) mirrored those of the original one. Interpretation: The robustness, flexibility, and generalisability of the Barcelona-BRS model support its consideration as a ready-to-use tool for clinical practice. Funding: None. |
| format | Article |
| id | doaj-art-4cb65fb9efaa4fde9fa06e1b95f2a3f8 |
| institution | DOAJ |
| issn | 2666-7762 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | The Lancet Regional Health. Europe |
| spelling | doaj-art-4cb65fb9efaa4fde9fa06e1b95f2a3f82025-08-20T03:18:54ZengElsevierThe Lancet Regional Health. Europe2666-77622025-06-015310130210.1016/j.lanepe.2025.101302The Barcelona baseline risk score to predict long-term prognosis after a first demyelinating event: a prospective observational studyResearch in contextCarmen Tur0Pere Carbonell-Mirabent1Susana Otero-Romero2Álvaro Cobo-Calvo3María Jesús Arévalo4Helena Ariño5Georgina Arrambide6Cristina Auger7René Carvajal8Joaquín Castilló9Manuel Comabella10Ingrid Galán11Luciana Midaglia12Carlos Nos13Agustín Pappolla14Deborah Pareto15Jordi Río16Breogán Rodríguez-Acevedo17Estibaliz Saez de Gordoa18Ángela Vidal-Jordana19Ana Zabalza20Jaume Sastre-Garriga21Àlex Rovira22Xavier Montalban23Mar Tintoré24Multiple Sclerosis Centre of Catalonia (Cemcat), Department of Neurology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; Corresponding author. Multiple Sclerosis Centre of Catalonia (Cemcat), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.Multiple Sclerosis Centre of Catalonia (Cemcat), Department of Neurology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, SpainMultiple Sclerosis Centre of Catalonia (Cemcat), Department of Neurology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, SpainMultiple Sclerosis Centre of Catalonia (Cemcat), Department of Neurology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, SpainMultiple Sclerosis Centre of Catalonia (Cemcat), Department of Neurology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, SpainMultiple Sclerosis Centre of Catalonia (Cemcat), Department of Neurology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, SpainMultiple Sclerosis Centre of Catalonia (Cemcat), Department of Neurology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, SpainSection of Neuroradiology, Department of Radiology, Vall d'Hebron University Hospital, Spain; Universitat Autònoma de Barcelona, Barcelona, SpainMultiple Sclerosis Centre of Catalonia (Cemcat), Department of Neurology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, SpainMultiple Sclerosis Centre of Catalonia (Cemcat), Department of Neurology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, SpainMultiple Sclerosis Centre of Catalonia (Cemcat), Department of Neurology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, SpainMultiple Sclerosis Centre of Catalonia (Cemcat), Department of Neurology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, SpainMultiple Sclerosis Centre of Catalonia (Cemcat), Department of Neurology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, SpainMultiple Sclerosis Centre of Catalonia (Cemcat), Department of Neurology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, SpainMultiple Sclerosis Centre of Catalonia (Cemcat), Department of Neurology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, SpainSection of Neuroradiology, Department of Radiology, Vall d'Hebron University Hospital, Spain; Universitat Autònoma de Barcelona, Barcelona, SpainMultiple Sclerosis Centre of Catalonia (Cemcat), Department of Neurology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, SpainMultiple Sclerosis Centre of Catalonia (Cemcat), Department of Neurology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, SpainSection of Neuroradiology, Department of Radiology, Vall d'Hebron University Hospital, Spain; Universitat Autònoma de Barcelona, Barcelona, SpainMultiple Sclerosis Centre of Catalonia (Cemcat), Department of Neurology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, SpainMultiple Sclerosis Centre of Catalonia (Cemcat), Department of Neurology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, SpainMultiple Sclerosis Centre of Catalonia (Cemcat), Department of Neurology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, SpainSection of Neuroradiology, Department of Radiology, Vall d'Hebron University Hospital, Spain; Universitat Autònoma de Barcelona, Barcelona, SpainMultiple Sclerosis Centre of Catalonia (Cemcat), Department of Neurology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; Universitat de Vic-Universitat Central de Catalunya (UVic-UCC), SpainMultiple Sclerosis Centre of Catalonia (Cemcat), Department of Neurology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; Universitat de Vic-Universitat Central de Catalunya (UVic-UCC), SpainSummary: Background: In multiple sclerosis (MS), predicting at symptom onset who will develop early and severe disability is an unmet need with significant therapeutic implications. Here we propose the Barcelona-Baseline Risk Score (BRS) model to predict long-term disease outcomes in a flexible and generalisable manner. Methods: Using prospectively acquired data from the Barcelona first-attack cohort, we created the Barcelona-BRS model as a set of six Weibull survival models of time to an Expanded Disability Status Scale score of 3.0, built with flexible combinations of predictors, including sex, age at first attack, and number and topography of T2 lesions, among others, adaptable to data availability. Data-driven risk groups were identified and compared in terms of long-term clinical and MRI outcomes, including relapse-associated worsening (RAW), progression independent of relapse activity (PIRA), conversion to secondary progressive MS (SPMS), lesional and brain volumetric data, and patient-reported/administered clinical scores, through Kaplan–Meier and mixed-effects models. Finally, we externally validated our model in a completely unseen cohort. Findings: We included 1074 patients (737 [69%] female, mean age: 31.7 years) with a first demyelinating attack. Over a median follow-up of 11.9 years, 375 (35%), 298 (28%), and 94 (8.8%) developed RAW, PIRA, and SPMS, respectively. Weibull models included age at first attack, number of brain T2 lesions, and disability at first visit as main predictors. Four data-driven groups of increasing risk of unfavourable outcomes were created: Light-Green-BRS (N = 258), Dark-Green-BRS (N = 319), Orange-BRS (N = 321), and Red-BRS (N = 176), which, over time, behaved significantly differently across disability, quality of life, and MRI measures, being the Red-BRS the group with worst outcomes (p < 0.01). The results in the external validation cohort (N = 139, 100 female [72%], 34 years) mirrored those of the original one. Interpretation: The robustness, flexibility, and generalisability of the Barcelona-BRS model support its consideration as a ready-to-use tool for clinical practice. Funding: None.http://www.sciencedirect.com/science/article/pii/S2666776225000948Multiple sclerosisPredictive modelDisease progressionMRIProgression independent of relapse activityRelapse-associated worsening |
| spellingShingle | Carmen Tur Pere Carbonell-Mirabent Susana Otero-Romero Álvaro Cobo-Calvo María Jesús Arévalo Helena Ariño Georgina Arrambide Cristina Auger René Carvajal Joaquín Castilló Manuel Comabella Ingrid Galán Luciana Midaglia Carlos Nos Agustín Pappolla Deborah Pareto Jordi Río Breogán Rodríguez-Acevedo Estibaliz Saez de Gordoa Ángela Vidal-Jordana Ana Zabalza Jaume Sastre-Garriga Àlex Rovira Xavier Montalban Mar Tintoré The Barcelona baseline risk score to predict long-term prognosis after a first demyelinating event: a prospective observational studyResearch in context The Lancet Regional Health. Europe Multiple sclerosis Predictive model Disease progression MRI Progression independent of relapse activity Relapse-associated worsening |
| title | The Barcelona baseline risk score to predict long-term prognosis after a first demyelinating event: a prospective observational studyResearch in context |
| title_full | The Barcelona baseline risk score to predict long-term prognosis after a first demyelinating event: a prospective observational studyResearch in context |
| title_fullStr | The Barcelona baseline risk score to predict long-term prognosis after a first demyelinating event: a prospective observational studyResearch in context |
| title_full_unstemmed | The Barcelona baseline risk score to predict long-term prognosis after a first demyelinating event: a prospective observational studyResearch in context |
| title_short | The Barcelona baseline risk score to predict long-term prognosis after a first demyelinating event: a prospective observational studyResearch in context |
| title_sort | barcelona baseline risk score to predict long term prognosis after a first demyelinating event a prospective observational studyresearch in context |
| topic | Multiple sclerosis Predictive model Disease progression MRI Progression independent of relapse activity Relapse-associated worsening |
| url | http://www.sciencedirect.com/science/article/pii/S2666776225000948 |
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