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SPECIAL REPORT

Effect of HE DMTs on PIRA
Anti-CD20 therapy and PIRA
Future use of PIRA

Progression independent of relapse activity (PIRA) has emerged as a means of identifying neurodegenerative processes that can occur at the earliest stages of the MS disease process and which contribute to disability accrual even when there is no evidence of disease activity. PIRA is generally defined as confirmed disability progression (CDP) during a relapse-free period (e.g. >30 days before and >90 days after relapse). Unfortunately, over 300 permutations of this definition have been described (Muller et al. JAMA Neurol 2025;82:614-625), which has made it difficult to compare the prevalence of PIRA and the impact of treatments across studies. Read More