EAN 2023 | Reviewing PIRA in multiple sclerosis
Jaume Sastre-Garriga, MD, PhD, Vall d’Hebron University Hospital, Barcelona, Spain, discusses the concept of progression independent of relapse activity (PIRA) in multiple sclerosis (MS). The majority of patients with primary progressive MS and secondary progressive MS experience a worsening of their condition despite the absence of any relapses, which aligns with the PIRA model. This new version of PIRA is significant because it occurs in phases previously associated only with relapsing-remitting MS. This means that even patients in the clinically isolated syndrome (CIS) phase or those who have experienced just one attack can experience their Expanded Disability Status Scale (EDSS) worsening. Understanding the significance of this concept is important because it can be applied early in the disease course, including in patients experiencing relapses or during the CIS phase. This interview took place at the European Academy of Neurology (EAN) 2023 Congress in Budapest, Hungary.
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Transcript (edited for clarity)
It’s important to gauge the relevance of this concept, let’s say, the added relevance. The concept of PIRA, so progression independent of relapses, in a way, is well known from very long time ago. So, we know that most patients with primary progressive MS, secondary progressive MS worsen in spite of not having any relapses. This is known for a long time, so, this is PIRA actually. The difference with this new version of this concept, and the one that we really call PIRA and we put the emphasis on, is that its occurring in a phase that before we thought it was relapsing-remitting MS only, and even in patients who may just be CIS or just one single attack and after that it could even have a worsening of EDSS...
It’s important to gauge the relevance of this concept, let’s say, the added relevance. The concept of PIRA, so progression independent of relapses, in a way, is well known from very long time ago. So, we know that most patients with primary progressive MS, secondary progressive MS worsen in spite of not having any relapses. This is known for a long time, so, this is PIRA actually. The difference with this new version of this concept, and the one that we really call PIRA and we put the emphasis on, is that its occurring in a phase that before we thought it was relapsing-remitting MS only, and even in patients who may just be CIS or just one single attack and after that it could even have a worsening of EDSS. So, the concept of EDSS progression as is defined independently or relapses has a novelty on the fact that can be applied very early in the disease, and particularly patients with relapsing-remitting phases, CIS phases.
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Disclosures
Over the last 12 months, Jaume Sastre-Garriga has engaged in consulting and/or participated as speaker/chair in events organized by Merck, BMS, Janssen, Sanofi and Roche.
