The disease course of patients with a confirmed diagnosis of primary progressive multiple sclerosis (PPMS) is uncertain. In an attempt to identify potential signaling pathways involved in the evolution of the disease, we conducted an exploratory unbiased lipidomic analysis of plasma from non‑diseased controls (n = 8) and patients with primary progressive MS (PPMS, n = 19) and either a rapid (PPMS‑P, n = 9) or slow (PPMS‑NP, n = 10) disease course based on worsening disability and/or MRI‑visible appearance of new T2 lesions over a one‑year‑assessment. Partial least squares‑discriminant analysis of the MS/MSALL lipidomic dataset, identified lipids driving the clustering of the groups. Among these lipids, sphingomyelin‑d18:1/14:0 and mono‑hexosylceramide‑d18:1/20:0 were differentially abundant in the plasma of ppMS patients compared to controls and their levels correlated with MRI signs of disease progression. Lyso‑phosphatidic acid‑18:2 (LPA‑18:2) was the only lipid with significantly lower abundance in PPMS patients with a rapidly deteriorating disease course, and its levels inversely correlated with the severity of the neurological deficit. Decreased levels of LPA‑18:2 were detected in patients with more rapid disease progression, regardless of therapy and these findings were validated in an independent cohort of secondary progressive (SPMS) patients, but not in a third cohorts of relapsing–remitting (RRMS) patients. Collectively, our analysis suggests that sphingomyelin‑d18:1/14:0, mono‑hexosylceramide‑d18:1/20:0, and LPA‑18:2 may represent important targets for future studies aimed at understanding disease progression in MS
