ArticleJournal of neurology2024
Progression independent of relapse activity in relapsing multiple sclerosis: impact and relationship with secondary progression.
Article in Journal of neurology, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 23 papers.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
23 citing papers in PubMed.
- Incidence of Progression Independent of Relapse Activity (PIRA) under platform disease-modifying treatment in multiple sclerosis.Journal of neurology · 2026Article
- Selected Cytokines and Matrix Metalloproteinases in Pathogenesis and Treatment of Multiple Sclerosis.International journal of molecular sciences · 2026Review
- Retinal Layer Thickness for Risk Stratification of Progression Independent of Relapse Activity in Relapsing-Remitting Multiple Sclerosis.Brain and behavior · 2026Observational
- Beyond relapse control: motor and cognitive subclinical progression in RRMS -a real-world longitudinal study of ocrelizumab and interferon beta.Acta neurologica Belgica · 2026Article
- GFAP and NfL as predictors of disease progression and relapse activity in fingolimod-treated multiple sclerosis.Brain : a journal of neurology · 2026Article
- Big data in multiple sclerosis.Current opinion in neurology · 2026Review
- Late-onset multiple sclerosis is associated with relapse-independent disability accrual: a propensity score-weighted recurrent-event study.Journal of neurology · 2026Article
- From Phenotypes to Spectrum: Rethinking RRMS, SPMS and PPMS in the Era of PIRA-A Framework Integrating PIRA, Smouldering-Associated Worsening, and Neurologic Reserve to Facilitate Earlier Recognition of Progression.Neurology international · 2026Review
- Detecting progressing events in multiple sclerosis clinics in real-time is possible: Yes.Multiple sclerosis (Houndmills, Basingstoke, England) · 2026Article
- A cause and protective treatment for acute and progressive disability and grey matter atrophy.Brain : a journal of neurology · 2026Review
- HerMeS: a registry-based evaluation of the HERCULES criteria for identifying nonrelapsing SPMS.Journal of neurology · 2026Article
- Autologous haematopoietic stem cell transplantation affects long-term progression independent of relapse activity in aggressive multiple sclerosis: a comparative matched study.Journal of neurology, neurosurgery, and psychiatry · 2026Article
- Multiple sclerosis as an asynchronous neuroinflammatory system.Frontiers in immunology · 2026Review
- Machine Learning Analysis Applied to Prediction of Early Progression Independent of Relapse Activity in Multiple Sclerosis Patients.European journal of neurology · 2025Article
- Toward a Unified Definition of Progression Independent of Relapse Activity in Multiple Sclerosis.Neurology · 2025Article
- Early Intensive Versus Escalation Approach: Ten-Year Impact on Disability in Relapsing Multiple Sclerosis.Annals of clinical and translational neurology · 2025Observational
- The use of high-efficacy disease-modifying therapies in multiple sclerosis: recommendations from an expert Delphi consensus.Journal of neurology · 2025Article
- A Window into New Insights on Progression Independent of Relapse Activity in Multiple Sclerosis: Role of Therapies and Current Perspective.International journal of molecular sciences · 2025Review
- MRI versus relapse: optimal activity monitoring for management of progressive multiple sclerosis.Brain communications · 2025Article
- Linking Pathogenesis to Fall Risk in Multiple Sclerosis.Archives of internal medicine research · 2025Article
Corrections and comments
- Erratum issued
Authors and funding
35 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesWe investigated the occurrence and relative contribution of relapse-associated worsening (RAW) and progression independent of relapse activity (PIRA) to confirmed disability accrual (CDA) and transition to secondary progression (SP) in relapsing multiple sclerosis (MS).
methodsRelapsing-onset MS patients with follow-up > / = 5 years (16,130) were extracted from the Italian MS Registry. CDA was a 6-month confirmed increase in Expanded Disability Status Scale (EDSS) score. Sustained disability accumulation (SDA) was a CDA with no EDSS improvement in all subsequent visits. Predictors of PIRA and RAW and the association between final EDSS score and type of CDA were assessed using logistic multivariable regression and multivariable ordinal regression models, respectively.
resultsOver 11.8 ± 5.4 years, 16,731 CDA events occurred in 8998 (55.8%) patients. PIRA (12,175) accounted for 72.3% of CDA. SDA occurred in 8912 (73.2%) PIRA and 2583 (56.7%) RAW (p < 0.001). 4453 (27.6%) patients transitioned to SPMS, 4010 (73.2%) out of 5476 patients with sustained PIRA and 443 (24.8%) out of 1790 patients with non-sustained PIRA. In the multivariable ordinal regression analysis, higher final EDSS score was associated with PIRA (estimated coefficient 0.349, 95% CI 0.120-0.577, p = 0.003). DISCUSSION: In this real-world relapsing-onset MS cohort, PIRA was the main driver of disability accumulation and was associated with higher disability in the long term. Sustained PIRA was linked to transition to SP and could represent a more accurate PIRA definition and a criterion to mark the putative onset of the progressive phase.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.