Modified Rio
Mod. Rio Score = 0
MRI Criterion
Relapase Criterion
About Modified RIO Score

Scoring treatment response in patients with relapsing multiple sclerosis
MP Sormani1, J Rio2, M Tintorè2, A Signori1, D Li3, P Cornelisse4, B Stubinski4, ML Stromillo5, X Montalban2* and N De Stefano5*

Background: We employed clinical and magnetic resonance imaging (MRI) measures in combination, to assess patient responses to interferon in multiple sclerosis.

Objective: To optimize and validate a scoring system able to discriminate responses to interferon treatment in patients with relapsing–remitting multiple sclerosis (RRMS).

Methods: Our analysis included two large, independent datasets of RRMS patients who were treated with interferons that included 4-year follow-up data. The first dataset (“training set”) comprised of 373 RRMS patients from a randomized clinical trial of subcutaneous interferon beta-1a. The second (“validation set”) included an observational cohort of 222 RRMS patients treated with different interferons. The new scoring system, a modified version of that previously proposed by Rio et al., was first tested on the training set, and then validated using the validation set. The association between disability progression and risk group, as defined by the score, was evaluated by Kaplan Meier survival curves and Cox regression, and quantified by hazard ratios (HRs). Results: The score (0–3) was based on the number of new T2 lesions (>5) and clinical relapses (0,1 or 2) during the first year of therapy. The risk of disability progression increased with higher scores. In the validation set, patients with score of 0 showed a 3-year progression probability of 24%, while those with a score of 1 increased to 33% (HR = 1.56; p = 0.13), and those with score greater than or equal to 2 increased to 65% (HR = 4.60; p < 0.001).

Conclusions: We report development of a simple, quantitative and complementary tool for predicting responses in interferon-treated patients that could help clinicians make treatment decisions.

Reference: Sormani MP, Rio J, Tintore M, Signori A, Li D, Cornelisse P, et al. Scoring treatment response in patients with relapsing multiple sclerosis. Mult Scler 2013; 19: 605–612. doi: 10.1177/1352458512460605

calculator reference: Sormani MP, De Stefano N. Nat Rev Neurol 2013;9:504-12

*MRI lesions: The cut-off of four lesions was in the validation set; the cut-off of five lesions was in the training set
*Abbreviation: EDSS, Expanded Disability Status Scale.
An evidence-based quantitative algorithm to monitor response to IFN‑β. This proposed algorithm is based on the Modified Rio Score for the assessment of the risk of progression over 4 years in patients with multiple sclerosis treated for 1.5 years with IFN‑β therapy*Substantial new T2 activity is defined as >4–5 new T2 lesions in 1 year of treatment or >1–2 new T2 lesions if the reference MRI scan to assess new T2 lesion formation is obtained at least 6 months after initiating therapy
Mod. Rio Score = 0