It can be difficult to notice when a patient is transitioning from relapsing-remitting multiple sclerosis to the secondary progressive form. Soon, neurologists may be able to use a digital tool to catch it.
A new digital tool could help neurologists more quickly notice when a patient with relapsing-remitting multiple sclerosis (RRMS) is transitioning to the secondary progressive form of the disease (SPMS).
Roughly half of patients with RRMS will eventually see their disease transition to SPMS, but diagnosing exactly when that shift occurs has been difficult.
Now, a new data-driven tool has been created that investigators believe will give physicians a better chance at catching the transition. The tool, called MSProDiscuss, is designed to facilitate physician-patient discussions and catch subtle changes that might indicate changes in the patient’s MS.
“The problem in diagnosing SPMS is that there are no defined criteria or gold standard,” co-creator Tjalf Ziemssen, MD, told The American Journal of Managed Care. “Cf course at the end, the patient´s history is relevant for the diagnosis. Our tool is an attempt to standardize this neurological history in an easy way.”
Ziemssen is a professor of clinical neuroscience at the Dresden University of Technology, in Germany. Ziemssen and colleagues’ findings are published this month in the Journal of Internet Medical Research.
In addition to helping to collect and process information, MSProDiscuss is designed to produce an easy-to-interpret output.
The tool pairs a mix of qualitative and quantitative information and with a scoring algorithm. To evaluate the tool, the research team asked 20 neurologists to use the tool to diagnose 198 patients whose MS status was already known. Of those patients, 89 had been diagnosed with RRMS, 47 had been diagnosed as transitioning to SPMS, and 62 had already been transitioned to SPMS.
The results from MSProDiscuss evaluation were highly accurate.
“The sensitivity for SPMS was consistently around 80% (true positive rate) and specificity (true negative rate) for RRMS above 86%,” the study notes. “Overall, the draft tool demonstrated excellent interrater reliability, and good evidence of construct validity using the known-groups method.”
The data showed that the impact and severity of symptoms for people transitioning to SPMS was markedly different from patients with RRMS, meaning it was possible to create meaningful cutoff values. In fact, while the tool was more accurate when Expanded Disability Status Scale (EDSS) scores were included, the new tool was also found to be accurate even without EDSS numbers.
“Why should neurologists use this tool?” Ziemssen said. “Because it is easy and quick to enter and it is possible to get semiquantitative standardized data which can be used in the long term and integrated in the holistic symptomatic management of MS patients.”
Now that the system has been validated in a study, Ziemssen said they must work to validate it in a clinical setting. The research team has already integrated the tool into another ongoing study that longitudinally monitors people with SPMS and people at high risk of SPMS. If successful, the tool could then be used to help optimize early interventions, which may slow the progression of the disease.
“Evidence from this study suggests the tool may be useful in clinical practice for a more informed physician-patient discussion supporting the successful management of MS,” Ziemssen and colleagues conclude.
The tool can already be accessed online.
Ziemssen T, Piani-Meier D, Bennett B, et al. A physician-completed digital tool for evaluating disease progression (Multiple Sclerosis Progression Discussion Tool): Validation Study. Journal of Medical Internet Research. 2020;22(2). doi:10.2196/16932.