The Neuroimmunology and AI (Computational Predictive Modelling) teams from the Clinical Neuroimmunology Research Group at Vall d’Hebron Research Institute (VHIR) and the Multiple Sclerosis Centre of Catalonia (Cemcat) have published the results of the first clinical tool capable of predicting the progression of multiple sclerosis (MS) from the initial event suggestive of a demyelinating disease, which is typically the first sign of the disease. This is the Barcelona-Baseline Risk Score (Barcelona-BRS), a model developed by the research team at Cemcat that incorporates a range of biological and clinical variables to classify each patient according to their likelihood of developing moderate long-term disability. The model has been validated in over 1,000 patients at Cemcat and confirmed with data from external patients.

The study, published in The Lancet Regional Health – Europe, shows that the Barcelona-BRS divides patients into four groups based on data such as age, sex and the location of initial lesions seen on magnetic resonance images. The categories, represented by colours, are light green (the most favourable, indicating the mildest progression), dark green, orange and red (the most severe progression). The results show clear differences between the groups: while only 3.5% of patients in the light green group reached a significant level of disability (grade 3 on the EDSS disability scale) over the years, this figure rose to 44% in the red group. In addition, high-risk patients had more brain lesions and lower scores on tests of health-related quality of life and cognitive function.

The Barcelona-BRS model stands out as the most comprehensive, as it incorporates multiple variables. For example, previous models did not account for magnetic resonance data, which is essential for understanding disease progression. At the same time, incorporating a large amount of information makes the model flexible and functional, even when some data are missing. This makes it a highly useful tool for real-world clinical practice, adaptable to different scenarios and the resources available in each geographical area. 

Since the mid-1990s, the use of disease-modifying therapies has achieved significant results in slowing the progression of MS. However, these therapies carry both economic and therapeutic costs, which require us to be highly precise in selecting the drug, route of administration and other factors. As Dr Xavier Montalban, Director of Cemcat, Consultant Neurologist at Vall d’Hebron University Hospital, and Head of the Clinical Neuroimmunology Research Group at Vall d’Hebron Research Institute (VHIR), explains: “Being able to predict the course of the disease from the outset is key to prescribing the most appropriate treatment in each case and avoiding unnecessary side effects.”

Age, gender and the presence of numerous T2 lesions on magnetic resonance are key factors in predicting disease progression.

The Barcelona-BRS model has identified several key factors that influence disease progression. Dr Carmen Tur, Neurologist at Vall d’Hebron University Hospital and researcher at Cemcat and VHIR, explains: “The variables associated with a poorer prognosis from the time of diagnosis are: Being male, having an older age at the first episode, spinal cord involvement and the presence of lesions visible on magnetic resonance – particularly in the infratentorial region. The key innovation is that the tool incorporates the weight of each factor into the overall prediction of each patient’s future disease progression.”

The model is now ready to be incorporated into routine clinical practice. However, the research team is continuing to work on future versions to achieve improvements that will make it even more precise. For example, initial testing (known as “differential diagnosis”) needs to be reinforced to confirm the MS diagnosis in some individuals in the light green group, as there have been cases where patients were later found to have other conditions with similar characteristics and therefore required a different therapeutic approach. Above all, the aim is to adapt the scale to new diagnostic tools and advances in research. “In recent years, the diagnostic value of tests such as determining neurofilament and glial fibrillary acidic protein levels has become increasingly evident. In the future, these could be incorporated into the list of variables used in the Barcelona-BRS to produce even more refined results,” notes Dr Mar Tintoré, neurologist, clinical lead at the Hospital, and researcher at Cemcat-VHIR.