Related Experiment Video
Updated: Sep 9, 2025
11:35
The Multiple Sclerosis Performance Test MSPT: An iPad-Based Disability Assessment Tool
Published on: June 30, 2014
58.1K
Persistent progression independent of relapse activity in multiple sclerosis
Chao Zhu1, Zhen Zhou2, Tomas Kalincik3,4
1Department of Neuroscience, School of Translational Medicine, Monash University, Melbourne, VIC 3004, Australia.
Brain Communications
|September 5, 2025
Summary
Disability progression in relapsing-remitting multiple sclerosis (RRMS) can reverse in one-third of patients. Younger age, lower baseline disability, and high-efficacy treatments predict this regression, reducing long-term disability risk.
Area of Science:
- Neurology
- Clinical Research
- Epidemiology
Background:
- Disability progression independent of relapse activity (PIRA) in relapsing-remitting multiple sclerosis (RRMS) can precede secondary progressive multiple sclerosis (SPMS).
- Understanding PIRA persistence is crucial for defining RRMS to SPMS transitions and informing treatment strategies.
- PIRA events may spontaneously regress, necessitating investigation into factors influencing persistence and non-persistence.
Purpose of the Study:
- To identify risk factors associated with the persistence and non-persistence of PIRA events in RRMS patients.
- To compare the long-term disability progression risks between patients with persistent and non-persistent PIRA.
- To examine the impact of baseline characteristics and treatment on PIRA regression.
Main Methods:
- A cohort study utilizing the MSBase registry (1995-2024) including 4713 RRMS patients with a PIRA event.
- Analysis of time to 6-month confirmed non-persistence of PIRA, time to Expanded Disability Status Scale (EDSS) 6, and time to SPMS.
- Propensity score matching was employed to compare outcomes between persistent and non-persistent PIRA groups, using stratified Cox regression models.
Main Results:
- Approximately one-third of RRMS patients experienced PIRA regression over a median follow-up of 8.7 years.
- Younger age, lower baseline EDSS, and use of high-efficacy disease-modifying therapies (DMTs) at baseline were associated with non-persistent PIRA (regression).
- Patients with non-persistent PIRA had significantly lower risks of reaching EDSS 6 (HR 0.19) and SPMS (HR 0.18) compared to those with persistent PIRA.
Conclusions:
- PIRA events can regress, with younger age, lower baseline disability, and high-efficacy DMT use predicting regression.
- Persistent PIRA is a significant risk factor for accelerated disability accumulation and progression to SPMS.
- These findings refine the understanding of PIRA dynamics and have implications for monitoring and managing RRMS patients.
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