CONy 2023 | What dictates MS progression: PIRA vs relapses

Giancarlo Comi, MD, Vita-Salute San Raffaele University, Milan, Italy, discusses whether relapses with incomplete remission or progression independent of relapse activity (PIRA) are most responsible for the accumulating disability in multiple sclerosis (MS). One of the hypotheses is that the progressive MS phase starts with disease onset or even in the preclinical phase. This position is driven by the existence of lesions that continue to evolve instead of resolving after the acute phase of inflammation. The opposite view considers that in the early stage, the damage is linked to the presence of new lesions predominantly related to inflammation. The degeneration phenomenon is not mandatory since early intervention can prevent the transformation of relapsing-remitting MS into progressive disease. This is highlighted by the efficacy of anti-inflammatory treatments and how they have completely changed the history of MS. This interview took place at the 17th World Congress on Controversies in Neurology (CONy) in Dubrovnik, Croatia.

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