Defining the Utility of PIRA in Practice

Opinion
Video

Ahmed Obeidat, MD, PhD, Stephen Krieger, MD, and Erin Longbrake, MD, PhD, explore the concept of progression independent of relapse activity (PIRA) and the challenges of defining subtle accumulation of disability.

This is a video synopsis/summary of a panel discussion involving Ahmed Obeidat, MD, PhD; Riley Bove, MD; Stephen Krieger, MD; and Erin Longbrake, MD, PhD.

The discussion revolves around the concepts of progression independent of relapse activity (PIRA) and relapse-associated worsening (RAW) in multiple sclerosis (MS) management. These concepts have become hot topics in conferences, indicating a shift in focus within the field. The conversation reflects on the significance of understanding these phenomena and their implications for patient care.

Experts emphasize the need to view MS on a continuum, considering both inflammatory and neurodegenerative components. They suggest that PIRA represents a subtle, gradual accumulation of disability, which has been historically overlooked in clinical research. The varying definitions of PIRA, such as based on time or disability scales, prompt a nuanced discussion on its interpretation and measurement.

The conversation touches upon contradictory findings, such as the time taken for recovery from relapses, challenging the traditional definitions of PIRA. However, experts stress the importance of looking beyond rigid definitions and focusing on the broader mandate for clinicians to observe and assess patients more carefully.

Overall, the discussion underscores the evolving understanding of MS progression and the importance of adapting clinical approaches to account for both relapse-related and independent disability accumulation.

Video synopsis is AI-generated and reviewed by NeurologyLive editorial staff.

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