A Predictive Model for Corticosteroid Response in Individual Patients with MS Relapses

ObjectivesTo derive a simple predictive model to guide the use of corticosteroids in patients with relapsing remitting MS suffering an acute relapse.Materials and MethodsWe analysed individual patient randomised controlled trial data (n=98) using a binary logistic regression model based on age, gender, baseline disability scores [physician-observed: expanded disability status scale (EDSS) and patient reported: multiple sclerosis impact scale 29 (MSIS-29)], and the time intervals between symptom onset or referral and treatment.ResultsBased on two a priori selected cut-off points (improvement in EDSS ≥ 0.5 and ≥ 1.0), we found that variables which predicted better response to corticosteroids after 6 weeks were younger age and lower MSIS-29 physical score at the time of relapse (model fit 71.2% - 73.1%).ConclusionsThis pilot study suggests two clinical variables which may predict the majority of the response to corticosteroid treatment in patients undergoing an MS relapse. The study is limited in being able to clearly distinguish factors associated with treatment response or spontaneous recovery and needs to be replicated in a larger prospective study.

研究目标：本研究旨在构建简易预测模型，以指导急性复发期复发缓解型多发性硬化（relapsing remitting MS）患者糖皮质激素的临床使用。材料与方法：我们采用基于年龄、性别、基线残疾评分[医师评估指标：扩展残疾状态量表（expanded disability status scale, EDSS）；患者自评指标：多发性硬化影响量表29（multiple sclerosis impact scale 29, MSIS-29）]以及症状发作或就诊至治疗的时间间隔的二元logistic回归模型，对98例患者的随机对照试验个体数据进行了分析。研究结果：基于预先设定的两个截断值（EDSS评分改善≥0.5分及≥1.0分），本研究发现，复发时年龄更轻、MSIS-29躯体功能评分更低的患者在治疗6周后对糖皮质激素的应答效果更佳，模型拟合度为71.2%~73.1%。研究结论：本初步研究提示，两项临床变量可预测多发性硬化复发患者糖皮质激素治疗的大部分应答效果。本研究存在局限性，无法明确区分与治疗应答及自发恢复相关的影响因素，后续需开展更大样本量的前瞻性研究以验证本结论。