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  • Early prediction of the long term evolution of multiple sclerosis: the Bayesian Risk Estimate for Multiple Sclerosis (BREMS) score

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Early prediction of the long term evolution of multiple sclerosis: the Bayesian Risk Estimate for Multiple Sclerosis (BREMS) score
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  1. Roberto Bergamaschi1,
  2. Silvana Quaglini2,
  3. Maria Trojano3,
  4. Maria Pia Amato4,
  5. Eleonora Tavazzi1,
  6. Damiano Paolicelli3,
  7. Valentina Zipoli4,
  8. Alfredo Romani1,
  9. Aurora Fuiani3,
  10. Emilio Portaccio4,
  11. Carlo Berzuini2,
  12. Cristina Montomoli5,
  13. Stefano Bastianello1,
  14. Vittorio Cosi1
  1. 1Multiple Sclerosis Centre, Neurological Institute C Mondino of Pavia, Pavia, Italy
  2. 2Department of Informatics and System Sciences, University of Pavia, Pavia, Italy
  3. 3Department of Neurological and Psychiatric Sciences, University of Bari, Bari, Italy
  4. 4Department of Neurological and Psychiatric Sciences, University of Florence, Florence, Italy
  5. 5Department of Health Sciences, Section of Medical Statistics and Epidemiology, University of Pavia, Pavia, Italy
  1. Correspondence to:
 Dr Roberto Bergamaschi
 Multiple Sclerosis Centre, Department of Clinical Neurology, Neurological Institute “C Mondino”, Via Mondino 2, 27100 Pavia, Italy; roberto.bergamaschi{at}mondino.it

Abstract

Aim: To propose a simple tool for early prediction of unfavourable long term evolution of multiple sclerosis (MS).

Methods: A Bayesian model allowed us to calculate, within the first year of disease and for each patient, the Bayesian Risk Estimate for MS (BREMS) score that represents the risk of reaching secondary progression (SP).

Results: The median BREMS scores were higher in 158 patients who reached SP within 10 years compared with 1087 progression free patients (0.69 vs 0.30; p<0.0001). The BREMS value was related to SP risk in the whole cohort (p<0.0001) and in the subgroup of 535 patients who had never been treated with immune therapies, thus reasonably representing the natural history of the disease (p<0.000001).

Conclusions: The BREMS score may be useful both to identify patients who are candidates for early or for more aggressive therapies and to improve the design and analysis of clinical therapeutic trials and of observational studies.

  • BREMS, Bayesian Risk Estimate for Multiple Sclerosis
  • EDSS, Expanded Disability Status Scale
  • LRR, local relative risk
  • MS, multiple sclerosis
  • RR, relapsing–remitting
  • SP, secondary progression

https://doi.org/10.1136/jnnp.2006.107052

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    Footnotes

    • Published Online First 12 January 2007

    • Competing interests: None.