Real-World Validation of the RoAD Score for Predicting Ambulatory Disability in MS

In a large real-world cohort, the RoAD score demonstrated robust performance for stratifying long-term risk of ambulatory decline in people with multiple sclerosis, offering a practical tool to prioritize monitoring and inform early management decisions.

Investigators tested the RoAD score to predict long-term irreversible ambulatory disability, using EDSS milestone attainment as the primary endpoint. The analysis showed strong predictive accuracy and clear risk discrimination across strata. Routinely collected demographic, clinical, and MRI variables at treatment initiation and after one year were combined into the score and validated against irreversible EDSS milestone outcomes, providing external validation in an unselected clinical population.

RoAD risk strata translate into actionable monitoring concepts. Higher-risk categories warrant intensified clinical review cadence, earlier or more frequent surveillance MRI, and a lower threshold for considering treatment escalation—used as guidance rather than prescriptive mandates.

Compared with other prognostic markers and composite models, the RoAD score offers complementary predictive value alongside imaging metrics, clinical features, and emerging biomarkers. Combined models that include fluid biomarkers or advanced neuroimaging parameters can add discriminatory power in selected contexts, while the RoAD score retains value as a pragmatic, broadly available index based on routine data.