Estimating Risk of Multiple Sclerosis Disease Reactivation in Pregnancy and Postpartum: The VIPRiMS Score

Area of Science:

• Neurology
• Reproductive Medicine
• Clinical Epidemiology

Background:

• Limited evidence exists for guiding personalized disease-modifying therapy (DMT) decisions around pregnancy in relapsing multiple sclerosis (RMS).
• Accurate risk assessment for disease reactivation is crucial for managing RMS during pregnancy.

Purpose of the Study:

• To develop and validate a predictive risk score for disease reactivation in RMS patients during and after pregnancy.
• To support individualized treatment strategies for pregnant individuals with RMS.

Main Methods:

• Utilized the Vienna Innsbruck MS database (VIMSD) with 343 pregnancies in RMS patients.
• Employed Cox regression to identify independent predictors of disease reactivation.
• Randomly assigned data into generation (2:1) and validation sets to create and test a 10-point risk score.

Main Results:

• Identified pre-conception DMT, washout duration, EDSS at conception, and postpartum DMT restart timing as key predictors (p < 0.001).
• The VIPRiMS score robustly predicted reactivation, explaining 75% of variance (p < 0.001).
• Stratified patients into high (≥6 points, 65% risk), intermediate (3-5 points, 24% risk), and low (≤2 points, 6% risk) reactivation categories.

Conclusions:

• The Vienna Innsbruck Pregnancy Risk in Multiple Sclerosis (VIPRiMS) score is a valuable clinical tool.
• It aids patients and neurologists in anticipating disease reactivation risk around pregnancy.
• Supports individualized treatment decision-making for pregnant RMS patients.