Observational studyMultiple sclerosis (Houndmills, Basingstoke, England)2026
Dissecting definitions of disability accrual in relapsing multiple sclerosis-Have we reached standardization yet?
Observational study in Multiple sclerosis (Houndmills, Basingstoke, England), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
2 citing papers in PubMed.
- 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
- Multiple sclerosis as an asynchronous neuroinflammatory system.Frontiers in immunology · 2026Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
12 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundDistinguishing relapse-associated worsening (RAW) and progression independent of relapse activity (PIRA) has reshaped understanding of disability accumulation in relapsing multiple sclerosis (RMS). The influence of differing definitions of disability accrual on event rates and RAW/PIRA proportions remains uncertain.
methodsThis observational cohort study used Austrian MS Treatment Registry data (2010-2024). A custom algorithm evaluated 1440 definitional variants of disability accrual with varying confirmation duration, baseline modeling, and RAW/PIRA classification, including recently proposed "standardized" criteria.
resultsWe included 3273 RMS patients (mean age 37.5 years; 67.8% female) with ⩾24 months follow-up, ⩾3 Expanded Disability Status Scale (EDSS) scores, and ⩾1 EDSS score per year, contributing 3525 follow-up periods. Depending on definition, disability accrual varied between 15.7% and 41.6% of follow-ups. PIRA accounted for 56.1%-86.3% of events across definitions, while up to 8.4% were ambiguously classified, mainly due to post-relapse re-baselining or relapses during the confirmation period. Even under "standardized" criteria, 144 definitional combinations remained, with event rates ranging from 19.1% to 21.7% and PIRA contribution varying widely from 59.8% to 85.8%.
conclusionPIRA predominantly drives disability accrual, yet definitional variation substantially influenced event rates and RAW/PIRA proportions. Transparent reporting and further optimization of definitions are critical for improving comparability, interpretation, and clinical relevance in MS research and care.
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