Revised criteria shorten time to MS diagnosis

The 2017 McDonald criteria shortened time to diagnosis of MS compared with the 2010 McDonald criteria, according to study results published in Neurology.

“Several aspects related to the performance of the 2017 revision of the McDonald criteria still need to be fully evaluated,” Massimo Filippi, MD, FEAN, FAAN, of the division of neuroscience at IRCCS San Raffaele Scientific Institute in Italy, and colleagues wrote. “The performance of these criteria has mainly been assessed in small, monocentric cohorts of [clinically isolated syndrome] CIS patients. Different outcomes have been used, including the estimation of [clinically definite MS] CDMS after a relatively short or heterogeneous follow-up, or by combining clinical (CDMS) with MRI (new lesions) status.”

Further, the effect of age and CIS topography on criteria performance, as well as the effect of treatment initiation on risk for developing CDMS, have not been fully explored. Also, the ability of the 2017 revisions to predict disability accumulation have not yet been explored, according to the researchers.

Filippi and colleagues aimed to compare the ability of the 2017 McDonald criteria revisions with the 2010 McDonald criteria to establish MS diagnosis and predict prognosis among patients with CIS that suggested MS. They examined cerebrospinal fluid and brain and spinal cord MRI data collected 5 months or fewer from CIS onset, as well as follow-up brain MRI data collected within 15 months of CIS onset, among 785 patients with CIS across nine European centers. They also obtained date of second clinical attack and of reaching Expanded Disability Status Score (EDSS) of three or more, if this occurred.

Further, the researchers evaluated performance of the two versions of the criteria for dissemination in space (DIS), time (DIT) and both (DIS and DIT) for predicting a second clinical attack and EDSS of three or more at follow-up. They estimated time to MS diagnosis for the two versions.

Results showed 406 of 785 patients with CIS developed CDMS at follow-up (median, 69.1 months). The 2017 DIS with DIT criteria showed higher sensitivity, lower specificity and similar area under the curve value at 36 months. The 2017 compared with the 2010 or CDMS criteria correlated with shorter median time to MS diagnosis. Both sets similarly predicted the EDSS of three or more milestone. Among patients aged 45 years or older, three periventricular lesions improved specificity.

“Overall, this study confirms that the 2017 McDonald criteria have higher sensitivity, lower specificity and overall similar accuracy compared with the 2010 McDonald criteria in predicting CDMS development independently from the type of clinical onset,” Filippi and colleagues wrote. “These criteria simplify the clinical use of MRI criteria without reducing accuracy and allow an earlier diagnosis of MS. Three periventricular lesions should be considered in future revisions of the McDonald criteria to improve the specificity and the accuracy in older CIS patients.”