Brief transmissions from the neural frontier.
Large French registry study of 10,499 MS patients found that high-efficacy therapies (HET) do not meaningfully prevent progression independent of relapse and MRI activity (PIRMA) compared to moderate-efficacy therapies, despite better control of inflammatory activity. This challenges the assumption that more potent anti-inflammatory treatments will prevent all forms of disability progression in MS.
Rollot et al, Brain 2026: Progression independent of relapse and MRI activity and treatment strategies in multiple sclerosis. Read the full paper.
Problem: There is a paradigmatic shift in MS care on its way as evidence is accumulating that using high-efficacy therapies (HET) in early stages of the disease prevents relapses and decreases evidence of disease activity on sequential MRI scans. Whether high-efficacy MS therapies can prevent progression independent of relapse and MRI activity (PIRMA) is an open questions.
Result: HET showed no meaningful advantage over moderate-efficacy therapies in preventing PIRMA, despite superior control of relapse-associated and MRI-associated worsening.
Open Questions: The underlying mechanisms driving PIRMA remain unclear, and whether alternative therapeutic strategies beyond current anti-inflammatory approaches might be needed to address this form of progression.
Written on February 21st , 2026 by Habakuk Hain