Ryan Haumschild, PharmD, MS, MBA, CPEL; Patricia K. Coyle, MD, and Kavita V. Nair, PhD, FAAN discuss how progression independent of relapse activity (PIRA) represents a critical driver of disability in multiple sclerosis that requires new therapeutic approaches, biomarkers for early identification, and treatment strategies that address both the relapsing inflammatory component and the underlying smoldering neurodegeneration that manifests clinically around midlife.
EP. 1: Understanding PIRA and Its Clinical Significance in MS
June 27th 2025Panelists discuss how progression independent of relapse activity (PIRA) represents a distinct pathological process involving smoldering inflammation and neurodegeneration that drives disability in patients with multiple sclerosis (MS), particularly manifesting around midlife despite being present from disease onset.
Watch
EP. 2: Measuring What Matters: Evidence and End Points That Define Disability in MS
June 27th 2025Panelists discuss how robust clinical evidence from major studies like the EPIC and OPERA trials demonstrates that progression independent of relapse activity (PIRA) is the primary driver of confirmed disability progression in patients with multiple sclerosis (MS), with clinical parameters over 3 to 6 months being the most meaningful measures of treatment impact.
Watch
EP. 3: Closing the Gaps: Therapeutic Performance and the Promise of Innovation
July 4th 2025Panelists discuss how current multiple sclerosis (MS) therapies show limited effectiveness against progression, but emerging Bruton tyrosine kinase (BTK) inhibitors offer promise by targeting both B cells and central nervous system (CNS)–penetrating microglia, with one showing a 31% reduction in confirmed disability progression in clinical trials.
Watch
EP. 4: Digging Deeper: Mechanisms of Progression and the Case for a Dual Therapeutic Approach
July 4th 2025Panelists discuss how chronic neuroinflammation involves distinct mechanisms from acute relapses—including microglial activation, mitochondrial dysfunction, and iron deposition—necessitating dual therapeutic approaches that address relapsing and progressive disease components.
Watch
EP. 5: Aligning Evidence With Access: Disability Outcomes, Data, and Payer Decision-Making
July 11th 2025Panelists discuss how emerging biomarkers like neurofilament light protein, glial fibrillary acidic protein (GFAP), cervical cord atrophy, and phase rim lesions could enable earlier identification of patients at risk for progression, supporting more effective treatment decisions and payer coverage determinations based on longitudinal disability data rather than just relapse activity.
Watch
EP. 6: Bridging the Gaps: BTK Inhibitors and the Future of MS Care
July 18th 2025Panelists discuss how BTK inhibitors represent a promising new oral therapy class that could address both inflammatory and neurodegenerative aspects of MS, particularly for progressive forms where treatment options are limited.
Watch
EP. 8: Short-Term Wins vs Long-Term Gains: Rethinking MS Treatment Value
July 25th 2025Panelists discuss how disability progression can be measured through practical clinical tools like patient-reported outcomes, timed walking tests, and dexterity assessments rather than relying solely on relapse rates.
Watch
EP. 9: Evaluating the Future of MS Therapies: Balancing Early Data With Delayed Outcomes
July 25th 2025Panelists discuss how the evaluation process must evolve to accommodate therapies that show benefits in slowing atrophy and motor decline over 1 to 2 years, emphasizing the need for early coverage rather than waiting for extensive long-term data.
Watch
EP. 11: The Value of Functional Outcomes and Elevating Patient Voices in MS Assessments
August 1st 2025Panelists discuss how patient-reported outcomes are crucial for capturing MS symptoms like fatigue, depression, and cognitive decline that significantly impact working-age patients but require standardization for practical clinical integration.
Watch