PIRA linked to worse quality of life in early RRMS patients
Researchers: Current clinical methods to monitor RRMS aren't PIRA-sensitive
Disability progression independent of relapse activity, or PIRA, in the earliest stages of relapsing-remitting multiple sclerosis (RRMS) is associated with worsening quality of life, a study in Sweden shows.
PIRA is a form of sustained disability worsening that occurs in the absence of multiple sclerosis (MS) relapses. While relapses were believed to be the main driver of disability progression in RRMS, evidence suggests PIRA is an important contributor and may affect patients from the onset of their disease. RRMS patients who have PIRA in the first five years after their diagnosis report worse quality of life in several patient-reported outcome measures, findings show.
“Our results support that PIRA has significant effects on [quality of life] in early RRMS,” the researchers wrote. The study, “Quality of life is decreased in persons with relapsing-remitting multiple sclerosis experiencing progression independent of relapse activity,” was published in the Multiple Sclerosis Journal.
People with MS often have reduced quality of life from the earliest stages of their disease. This is often used to guide clinical decisions and some trials have included quality of life as an outcome measure to assess treatment efficacy.
Disability progression in MS can occur due to an incomplete recovery from a relapse, meaning some symptoms that appeared or worsened during the relapse remained even after the relapse resolved, or in the absence of relapses. While available disease-modifying therapies are good at reducing relapse-associated worsening, their effects are far more limited with PIRA.
Impact of PIRA
Here, researchers in Sweden explored if having PIRA in the early years after a diagnosis impacted quality of life. Between 2014 and 2016, they enrolled 125 newly diagnosed adults with RRMS who hadn’t received treatment and continuously assessed them for progression and quality of life over five years.
Twenty-four patients (19.2%) had PIRA during the follow-up. This was defined as a sustained increase in Expanded Disability Status Scale (EDSS) scores, or a greater than 20% decrease in either the nine-hole peg test (9HPT) or the Timed 25-Foot Walk (T25-FW) test scores. The 9HPT assesses dexterity, or ability to use the fingers and hands to perform tasks, while T25-FW measures how quickly a person can walk 25 feet to assess walking function. This worsening had to be observed at least three months before a relapse or one month after one.
Among those who experienced PIRA, most fulfilled the criteria due to increases in EDSS scores (62.5%), while only about 1 in 5 had worsening dexterity (16.7%) or walking function (20.8%). Those with and without PIRA had received DMTs with a similar efficacy, supporting the idea that existing drugs aren’t very effective at preventing PIRA.
At the study’s start, quality of life scores in a range of measures were similar between the two groups. However, after five years, those with PIRA consistently reported worse quality of life in those outcome measures. Those who didn’t have PIRA saw quality of life improvements over the same period.
“Our results suggest that the current clinical methods used for RRMS monitoring are not sensitive to PIRA, and highlight that deterioration of [quality of life] is strongly associated with PIRA and should be monitored and recognized as an important aspect of progression,” the researchers wrote.
About the Author
