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b-o-b
3 weeks ago

@mattw Hi,

RRMS and SPMS are not very good concepts to understand MS in 2020.

To my mind, better to think about PIRA (progression independent of relapse activity) and RAW (relapse-associated worsening). Every pwMS is different and basically everyone experiences a combination of PIRA and RAW. Some experience only RAW and no PIRA for a while and are being called RRMS and some others only have PIRA and are called PPMS or SPMS (if they were RRMS before). And a lot of people with ‘RRMS’ experience both RAW and PIRA, from the start.

So basically you can have focal inflammation (which is your case: you have new MRI lesions) but maybe also some PIRA.

What is really important is to do something about it.

First, you need to take care of focal inflammations so if Tec is not good enough (which seems to the case), you really need to change your DMT. Did you have an MRI of rebasline after 6 months of Tec or was it your first one after you begin Tec? When is your next MRI?

Secondly, if you think you experience PIRA, you need a DMT that has an effect on that too. All the DMTs we have in 2020 are not great to fight PIRA (they are good on RAW), but some are better than others: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7281382/