The following is a summary of “Disability patterns in multiple sclerosis: A meta-analysis on RAW and PIRA in the real-world context,” published in the July 2024 issue of Neurology by Prosperini et al.
Researchers conducted a retrospective study to systematically review and analyze real-world data on relapse-associated worsening and progression independent of relapse activity in multiple sclerosis (MS).
They searched scientific databases to find appropriate articles. Random-effects meta-analyses, subgroup analyses, and meta-regression models were conducted to estimate pooled RAW and PIRA events and identify the possible moderators.
The results showed 18 articles fulfilled the criteria, encompassing 52,667 patients (93% relapsing-remitting, 6% clinically isolated syndrome, 1% progressive) tracked for 2.4 to 12.1 years, totaling 415,825 patient-years. The pooled event rates were 1.6 (95% CI = 1.1–2.1) for RAW and 3.1 (95% CI = 2.3–3.9) for PIRA per 100 patient years. Fewer RAW events occurred in groups with progressive patients (β = −0.069, P=0.006) and those on high-efficacy disease-modifying treatments (DMTs) (β = −0.031, P=0.007), whereas PIRA events were associated with older age (β = 0.397, P=0.027). Differences in PIRA rates were observed based on the criteria for confirming disability accrual (P<0.05).
Investigators concluded that progression independent of relapse activity was the primary driver of disability accumulation in MS, while relapse-associated worsening was less common due to improved treatments, and challenges in detecting and analyzing PIRA outcomes can lead to biased findings.
Source: journals.sagepub.com/doi/abs/10.1177/13524585241266180
