Related Experiment Video
Updated: May 23, 2025
The Multiple Sclerosis Performance Test MSPT: An iPad-Based Disability Assessment Tool
Published on: June 30, 2014
Development of early progression independent of relapse activity significantly impacts on disability accumulation in
María Agustina Zárate1, Mariano Marrodan1, María Agustina Piedrabuena1
1Departamento de Neurología, Fleni, Buenos Aires, Argentina.
Background:
Disability accumulation in multiple sclerosis (MS) is driven by relapse-associated worsening (RAW) and progression independent of relapse activity (PIRA). Early PIRA (EP), occurring within five years of disease onset, has been proposed as a critical marker of poor prognosis. However, risk factors for EP remain poorly defined.
Objective:
To identify clinical and demographic factors associated with EP and assess its impact on long-term disability accumulation.
Methods:
This retrospective cohort study included 143 relapsing-remitting MS patients with disability progression (EDSS 4, 6, or 8) primarily due to PIRA. Patients were categorized as EP (PIRA within five years of onset) or late PIRA (LP, after five years). Cox regression and Kaplan-Meier survival analyses assessed risk factors and disability progression.
Results:
EP was identified in 39/77 (51 %) of PIRA patients. EP patients were older at diagnosis (38.6 vs. 34 years, p = 0.01), predominantly female (p = 0.02), and more likely to have spinal cord onset symptoms (p < 0.01). EP patients reached EDSS 4, 6, and 8 significantly faster than LP patients (p < 0.01). In multivariate analysis, spinal cord onset was the strongest predictor of EP (HR=2.1, 95 %CI=1.05-4.44, p = 0.03).
Conclusions:
EP occurs in half of PIRA patients and is associated with spinal cord onset and older age at diagnosis. These findings highlight the need for early identification and aggressive treatment to mitigate long-term disability. Further research is required to refine predictive models and optimize therapeutic strategies for high-risk patients.
Insights
Early progression independent of relapse activity (PIRA) in multiple sclerosis (MS) affects half of patients and is linked to spinal cord onset and older age at diagnosis. Identifying these patients early is crucial for managing long-term disability.
Area of Science:
- Neurology
- Clinical Research
- Epidemiology
Background:
- Multiple sclerosis (MS) disability accrual stems from relapse-associated worsening (RAW) and progression independent of relapse activity (PIRA).
- Early PIRA (EP), defined as PIRA within five years of disease onset, is a potential indicator of poor prognosis.
- Risk factors for EP remain inadequately defined.
Purpose of the Study:
- To pinpoint clinical and demographic factors linked to EP in MS patients.
- To evaluate the influence of EP on long-term disability accumulation.
Main Methods:
- Retrospective cohort study of 143 relapsing-remitting MS patients with PIRA-driven disability progression (EDSS 4, 6, or 8).
- Patients classified as EP (PIRA within 5 years) or late PIRA (LP, >5 years).
- Cox regression and Kaplan-Meier analyses used to identify risk factors and assess disability progression.
Main Results:
- EP occurred in 51% of PIRA patients.
- EP patients were older at diagnosis (38.6 vs. 34 years), more likely female, and had higher rates of spinal cord onset.
- EP patients experienced significantly faster accumulation of disability (EDSS 4, 6, 8) compared to LP patients.
- Spinal cord onset was the strongest predictor of EP (HR=2.1).
Conclusions:
- EP is prevalent in PIRA patients and associated with spinal cord onset and older age at diagnosis.
- Early identification and aggressive treatment are vital for mitigating long-term MS disability.
- Further research is needed to refine predictive models and optimize treatment for high-risk MS patients.
