Predictors of early disability accumulation in newly diagnosed multiple sclerosis: clinical, imaging and cerebrospinal fluid measures DOI Creative Commons
Markus Lauerer, Tun Wiltgen,

Claudia Brückner

et al.

Journal of Neurology Neurosurgery & Psychiatry, Journal Year: 2025, Volume and Issue: unknown, P. jnnp - 335037

Published: Feb. 17, 2025

Background A growing arsenal of treatment options for relapsing multiple sclerosis (RMS) emphasises the need early prognostic biomarkers. While evidence individual markers exists, comprehensive analyses at time diagnosis are sparse. Methods Brain and spinal cord lesion numbers, cerebrospinal fluid parameters, initial symptoms, Expanded Disability Status Scale (EDSS) score were determined diagnosis. Confirmed disability accumulation (CDA), defined as a sustained EDSS increase over 6 months, was during 5-year follow-up. All-subsets multivariable logistic regression performed to identify predictors CDA. Model performance assessed via receiver operating characteristic analysis, risks calculated. Analyses repeated with progression independent relapse activity (PIRA) an outcome. Results 113/417 (27.1%) people RMS experienced CDA on Intrathecal IgG synthesis, higher number lesions, age polysymptomatic manifestation identified The resulting prediction model yielded area under curve (AUC) 0.75 95% CI 0.70 0.80. Individuals exceeding optimal thresholds three most significant had 61.8% likelihood experiencing CDA, whereas those below all rate 4.5%. only baseline predictor differentiating PIRA from relapse-associated worsening lesions (AUC=0.64, 0.54 0.74). Conclusions number, in newly diagnosed RMS.

Language: Английский

Disability patterns in multiple sclerosis: A meta-analysis on RAW and PIRA in the real-world context DOI
Luca Prosperini, Serena Ruggieri, Shalom Haggiag

et al.

Multiple Sclerosis Journal, Journal Year: 2024, Volume and Issue: 30(10), P. 1309 - 1321

Published: July 31, 2024

To summarize the current evidence on relapse-associated worsening (RAW) and progression independent of relapse activity (PIRA) through a quantitative synthesis real-world studies.

Language: Английский

Citations

5
The contribution of tumor necrosis factor to multiple sclerosis: a possible role in progression independent of relapse? DOI Creative Commons
Valentina Mazziotti, Francesco Crescenzo, Ermanna Turano

et al.

Journal of Neuroinflammation, Journal Year: 2024, Volume and Issue: 21(1)

Published: Aug. 21, 2024

Tumor necrosis factor (TNF) is a pleiotropic cytokine regulating many physiological and pathological immune-mediated processes. Specifically, it has been recognized as an essential pro-inflammatory implicated in multiple sclerosis (MS) pathogenesis progression. MS chronic disease of the central nervous system, characterized by multifocal acute inflammatory demyelination white grey matter, along with neuroaxonal loss. A recent concept field research disability resulting from Progression Independent Relapse Activity (PIRA). PIRA recognizes that accumulation since early phase can occur independently relapse activity overcoming traditional dualistic view either relapsing-inflammatory or progressive-neurodegenerative disease. Several studies have demonstrated upregulation TNF expression both active brain lesions. Additionally, elevated levels observed serum cerebrospinal fluid patients. appears to play significant role maintaining intrathecal inflammation, promoting axonal damage neurodegeneration, consequently contributing progression accumulation. In summary, this review highlights current understanding its receptors progression, specifically focusing on relatively unexplored condition. Further area holds promise for potential therapeutic interventions targeting mitigate

Language: Английский

Citations

5
Prevalence of Progression Independent of Relapse Activity and Relapse-Associated Worsening in Patients With AQP4-IgG–Positive NMOSD DOI
Pakeeran Siriratnam, Saif Huda, Anneke van der Walt

et al.

Neurology, Journal Year: 2024, Volume and Issue: 103(12)

Published: Nov. 19, 2024

In aquaporin-4 antibody-positive neuromyelitis optica spectrum disorder (AQP4-IgG NMOSD), disability accrual is mostly attributed to relapses. This study aimed assess the prevalence of progression independent relapse activity (PIRA) and relapse-associated worsening (RAW) in AQP4-IgG NMOSD. was a retrospective cohort patients with NMOSD enrolled MSBase international data registry. Patients required minimum 3 recorded Expanded Disability Status Scale (EDSS) scores: baseline, event, 6-month confirmation score. Presence absence relapses between baseline event EDSS scores determined RAW PIRA, respectively. Descriptive statistics were used present results. A total 181 followed for median 4.5 years (Q1 1.7, Q3 7.8) included. Most female (88.4%), age at disease onset 38.1 years. Overall, 4 (2.2%) developed 5 incidences PIRA 13 (7.2%). multicenter highlights that very rare Limitations this include sole focus overall measure disability, lack requirement second score confirm EDSS, magnetic resonance imaging information all patients.

Language: Английский

Citations

5
A Window into New Insights on Progression Independent of Relapse Activity in Multiple Sclerosis: Role of Therapies and Current Perspective DOI Open Access
Tommaso Guerra, Pietro Iaffaldano

International Journal of Molecular Sciences, Journal Year: 2025, Volume and Issue: 26(3), P. 884 - 884

Published: Jan. 21, 2025

In multiple sclerosis (MS), there is significant evidence indicating that both progression independent of relapse activity (PIRA) and relapse-related worsening events contribute to the accumulation progressive disability from onset disease throughout its course. Understanding compartmentalized pathophysiology MS would enhance comprehension mechanisms, overcoming traditional distinction in phenotypes. Smoldering thought be maintained by a continuous interaction between parenchymal chronic processes neuroinflammation neurodegeneration intrathecal compartment. This review provides comprehensive up-to-date overview neuropathological immunological related mechanisms underlying PIRA phenomena MS, with focus on studies investigating impact currently available therapies these complex mechanisms.

Language: Английский

Citations

0
Predictors of early disability accumulation in newly diagnosed multiple sclerosis: clinical, imaging and cerebrospinal fluid measures DOI Creative Commons
Markus Lauerer, Tun Wiltgen,

Claudia Brückner

et al.

Journal of Neurology Neurosurgery & Psychiatry, Journal Year: 2025, Volume and Issue: unknown, P. jnnp - 335037

Published: Feb. 17, 2025

Background A growing arsenal of treatment options for relapsing multiple sclerosis (RMS) emphasises the need early prognostic biomarkers. While evidence individual markers exists, comprehensive analyses at time diagnosis are sparse. Methods Brain and spinal cord lesion numbers, cerebrospinal fluid parameters, initial symptoms, Expanded Disability Status Scale (EDSS) score were determined diagnosis. Confirmed disability accumulation (CDA), defined as a sustained EDSS increase over 6 months, was during 5-year follow-up. All-subsets multivariable logistic regression performed to identify predictors CDA. Model performance assessed via receiver operating characteristic analysis, risks calculated. Analyses repeated with progression independent relapse activity (PIRA) an outcome. Results 113/417 (27.1%) people RMS experienced CDA on Intrathecal IgG synthesis, higher number lesions, age polysymptomatic manifestation identified The resulting prediction model yielded area under curve (AUC) 0.75 95% CI 0.70 0.80. Individuals exceeding optimal thresholds three most significant had 61.8% likelihood experiencing CDA, whereas those below all rate 4.5%. only baseline predictor differentiating PIRA from relapse-associated worsening lesions (AUC=0.64, 0.54 0.74). Conclusions number, in newly diagnosed RMS.

Language: Английский

Citations

0