A proof-of-concept application of a novel scoring approach for personalized medicine in multiple sclerosis

• Published in: Multiple sclerosis 2020-08, Vol.26 (9), p.1064-1073
• Main Authors: Pellegrini, Fabio, Copetti, Massimiliano, Bovis, Francesca, Cheng, David, Hyde, Robert, de Moor, Carl, Kieseier, Bernd C, Sormani, Maria Pia
• Format: Article
• Language: English
• Subjects: Clinical trials; Multiple sclerosis; Patients; Precision medicine; Visual perception
• ISSN: 1352-4585; 1477-0970
• DOI: 10.1177/1352458519849513

Background: Stratified medicine methodologies based on subgroup analyses are often insufficiently powered. More powerful personalized medicine approaches are based on continuous scores. Objective: We deployed a patient-specific continuous score predicting treatment response in patients with relapsing-remitting multiple sclerosis (RRMS). Methods: Data from two independent randomized controlled trials (RCTs) were used to build and validate an individual treatment response (ITR) score, regressing annualized relapse rates (ARRs) on a set of baseline predictors. Results: The ITR score for the combined treatment groups versus placebo detected differential clinical response in both RCTs. High responders in one RCT had a cross-validated ARR ratio of 0.29 (95% confidence interval (CI) = 0.13–0.55) versus 0.62 (95% CI = 0.47–0.83) for all other responders (heterogeneity p = 0.038) and were validated in the other RCT, with the corresponding ARR ratios of 0.31 (95% CI = 0.18–0.56) and 0.61 (95% CI = 0.47–0.79; heterogeneity p = 0.036). The strongest treatment effect modifiers were the Short Form-36 Physical Component Summary, age, Visual Function Test 2.5%, prior MS treatment and Expanded Disability Status Scale. Conclusion: Our modelling strategy detects and validates an ITR score and opens up avenues for building treatment response calculators that are also applicable in routine clinical practice.