Multiple sclerosis and related disorders · 2025
Progression independent of relapse activity (PIRA) in the Era of high-efficacy treatments.
СтатьяНазвание и аннотация: Перевод в очереди
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Alonso Ricardo, Casas Magdalena, Rojas Juan Ignacio, Eizaguirre Maria Barbara, Lazaro Luciana, Pita Cecilia, Cohen Leila, Carnero Contentti Edgar, Mainella Carolina, Patrucco Liliana, Leguizamon Felisa, Cabrera Lorena Mariela, Tizio Santiago, Zanga Gisela, Liguori Nora Fernandez, Piedrabuena Raul, Liwacki Susana, Miguez Jimena, Tkachuk Veronica, Silva Berenice
Аннотация
BACKGROUND: Progression independent of relapse activity (PIRA) is a key marker of chronic neurodegeneration in multiple sclerosis (MS), reflecting sustained disability progression unrelated to inflammatory relapses. While high-efficacy therapies (HETs) have significantly reduced relapse-associated worsening (RAW), the contribution of PIRA to disability progression has increased in recent diagnostic periods.
OBJECTIVES: This study aimed to evaluate the prevalence and predictors of PIRA in Argentine patients with relapsing-remitting MS (RRMS) receiving HETs and to explore the impact of early treatment initiation on disease progression.
METHODS: A post hoc analysis of the Argentine MS registry (RelevarEM) was conducted, including RRMS patients treated with natalizumab, alemtuzumab, cladribine (Cladribine), rituximab, or ocrelizumab. Patients required ≥1 relapse in the preceding 12 months, biannual EDSS assessments, and annual MRI scans. PIRA was defined as EDSS progression (≥1.0 or ≥0.5 points, depending on baseline score) confirmed 24 weeks apart, outside the relapse period. Logistic regression identified predictors of PIRA.
RESULTS: Among 287 patients (68.2 % female, mean age 37.33±11.10 years), 22 (7.7 %) developed PIRA. PIRA patients were older (42.58±13.46 vs. 36.85±10.79 years, p = 0.015) and had longer disease duration (6.87±6.18 vs. 4.41±4.96 years, p = 0.023). Treatment-naïve patients showed lower PIRA risk (OR=0.10, p = 0.0049), while absence of prior relapses increased risk (OR=8.17, p = 0.0087).
CONCLUSIONS: PIRA prevalence was lower in this cohort compared to prior studies, reflecting the effectiveness of HETs in RRMS. Early initiation of HETs is critical to mitigating PIRA and long-term disability. These findings underscore the need for timely diagnosis and treatment to alter MS progression.
OBJECTIVES: This study aimed to evaluate the prevalence and predictors of PIRA in Argentine patients with relapsing-remitting MS (RRMS) receiving HETs and to explore the impact of early treatment initiation on disease progression.
METHODS: A post hoc analysis of the Argentine MS registry (RelevarEM) was conducted, including RRMS patients treated with natalizumab, alemtuzumab, cladribine (Cladribine), rituximab, or ocrelizumab. Patients required ≥1 relapse in the preceding 12 months, biannual EDSS assessments, and annual MRI scans. PIRA was defined as EDSS progression (≥1.0 or ≥0.5 points, depending on baseline score) confirmed 24 weeks apart, outside the relapse period. Logistic regression identified predictors of PIRA.
RESULTS: Among 287 patients (68.2 % female, mean age 37.33±11.10 years), 22 (7.7 %) developed PIRA. PIRA patients were older (42.58±13.46 vs. 36.85±10.79 years, p = 0.015) and had longer disease duration (6.87±6.18 vs. 4.41±4.96 years, p = 0.023). Treatment-naïve patients showed lower PIRA risk (OR=0.10, p = 0.0049), while absence of prior relapses increased risk (OR=8.17, p = 0.0087).
CONCLUSIONS: PIRA prevalence was lower in this cohort compared to prior studies, reflecting the effectiveness of HETs in RRMS. Early initiation of HETs is critical to mitigating PIRA and long-term disability. These findings underscore the need for timely diagnosis and treatment to alter MS progression.