Predicting multiple sclerosis prognosis using AI and machine learning: integrating clinical, immunological, and radiological variables.

Introduction: Accurate prediction of disease progression in multiple sclerosis (MS) remains a critical challenge in clinical management. This study investigates the utility of supervised machine learning (ML) models in predicting clinical disability, as measured by the Expanded Disability Status Scale (EDSS), and radiological activity based on MRI lesion changes in patients with relapsing-remitting MS (RRMS). Methods: Using peripheral cytokine profiles (IL-12, TNF-α, IFN-γ, IL-4, IL-10) along with patient metadata (e.g., sex, family history, relapse status), 43 ML classifiers were trained and evaluated for their ability to discriminate between mild and moderate disability (EDSS <1 vs >1, and <2.5 vs >2.5), and to predict new MRI lesions in 15 MS patients. Results: Ensemble models consistently outperformed simpler algorithms. For EDSS prediction, Random Forest achieved 90.1% sensitivity and 89.7% specificity, while Simple Logistic Regression reached 92.6% for both metrics when patient ID was included. In predicting new MRI lesions, Random Subspace classifiers performed best, with 82.4% sensitivity and specificity. Discussion: These findings suggest that combining cytokine-based immune signatures with machine learning strategies can provide clinically meaningful predictions of both functional disability and radiological progression. Such tools may support more proactive patient monitoring, informed therapeutic decision-making, and risk stratification in the care of RRMS. Further validation in prospective cohorts is warranted to support clinical implementation.