Pharmacist Best Practices in Early Detection and Disability Identification

In this episode, Pharmacist Best Practices in Early Detection and Disability Identification, Ryan Fuller, PharmD, and Aimee Banks, PharmD, BCPS, MSCS, explore PIRA as a central driver of MS disability, as well as pharmacist best practices in early detection and disability identification.

Multiple sclerosis (MS) has traditionally been viewed as a disease driven primarily by inflammatory relapses; however, growing evidence has revealed that disability progression often occurs independently of overt relapse activity. This phenomenon, known as Progression Independent of Relapse Activity (PIRA), describes the gradual accumulation of neurologic impairment that can develop even when patients appear clinically stable and imaging shows minimal new inflammatory lesions. PIRA reflects underlying neurodegenerative processes, chronic compartmentalized inflammation, and ongoing axonal loss that are not fully captured by relapse-based disease monitoring. Recognition of PIRA has fundamentally changed the understanding of MS, positioning it as a key driver of long-term disability and emphasizing the need for continuous assessment beyond relapse frequency alone.

As the understanding of MS progression evolves, pharmacists are emerging as vital contributors to early disease detection and disability identification. Because pharmacists often interact with patients more frequently than other health care providers, they are uniquely positioned to recognize subtle changes in physical function, cognition, fatigue, or treatment response that may signal early progression. Best practices include actively engaging patients in conversations about symptom changes, monitoring medication adherence and persistence, identifying barriers to therapy, and encouraging prompt reporting of new or worsening symptoms to neurology teams. Pharmacists can also assist in interpreting treatment goals, reinforcing the importance of early and sustained therapy, and facilitating referrals for further evaluation when concerning signs arise.

Led by the moderator, the neurology pharmacists examine the following critical questions:

What is PIRA (Progression Independent of Relapse Activity), and why is it now seen as a key driver of disability in MS?

What are best practices for pharmacists in early detection of the disease and aiding in disability identification?

Throughout the conversation, the experts provide a comprehensive reflection on the field and the factors that may shape how clinicians approach care moving forward.

The next episode in this series, Biomarkers, Evolving Subtypes, and Redefining Disease Classification in Multiple Sclerosis, features the panelists advancing their conversation on multiple sclerosis and focusing on the role of biomarkers in MS management and key updates in the classification of subtypes.