NEPAD (knee pad) is a new way to view progression

We are all aware of NEDA but have you heard of NEPAD?

We are all well aware of NEDA (pronounced Nee Dah), which is No Evidence of Disease Activity and relates to no gadolium enhancing/T2 lesions, no clinical relapses and no worsening of mobility. Then we can do NEDA-NFL, which is NEDA-4/5 and is NEDA-3 and no evidence of the production of neurofilaments as a marker of nerve damage. But as we start to see new studies on progressive (advance) MS we hear of a new abbreviation NEPAD (Knee Pad). This is No Evidence of Progression or Active Disease. Which is abit more stringent than NEDA as it brings in effects on 9 hole peg test (hand function) as well as walking.

The guys at Roche have been busy and have been looking at the disability progression on people with relapsing MS and have tried to estimate how much of the increase in disability was due to the effect of relapsing attacks which they have called RAW (Relapse-associated worsening) and PIRA (pronounced Peera) for Progression independent of Relapse Activity. Maybe ProfG will tell us how they calculate this, but the baseline is changed during the analysis to determine that can not be related to a relapse. This PIRA will feed into NEPAD.

 PIRA is a newly emerging MS endpoint intended to measure an increase in disability, which is related to underlying disease activity in Relapsing MS. This is  measured by composite Confirmed Disease Progression (cCDP) is a measure of the risk of a person’s physical disability getting worse and is based on three measures of physical disability,: confirmed disability progression (CDP), walking speed and upper extremity function.
This says that the progression of disability occuring on people with MS treated with ocrelizumab is largely due to progression independent of relapse activity, clearly showing that progression in MS is not a distinct disease stage but is occuring throughout the disease course. So MS is One disease.

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  • Thanks for the post MD.

    If PIRA exists from the onset of the disease and MS is one disease, what does this say that MS treatments today?

    It shows shows that neuroprotective, remyelination and neurorestorative treatments are every bit as important as the current "neuroinflammatory only" approach to treatment from the very onset of MS.

  • I don't think this blog is the place to come for information on neuroprotectives; it's mainly about promotion of the same old aggressive anti-inflammatories. Sorry, just saying what I feel. I am looking elsewhere for hopeful information.

    • Good luck with your search. Anti-inflammatories are king and are a constant source of income for big pharma.

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