Serum NfL predicts long-term clinical outcomes in MS

Higher serum levels of neurofilament light chain (NfL) close to the time of multiple sclerosis (MS) disease onset is a sensitive marker for subsequent relatively poor clinical outcomes. This is suggested by results of a prospective cohort study with over 15 years of follow-up [1]. The authors claim that these patients may benefit from a more aggressive initial treatment.

Researchers from the Ottawa Hospital Research Institute (Canada) evaluated the prognostic value of serum NfL levels obtained shortly after MS diagnosis to identify patients likely to have a more aggressive disease course. A total of 67 MS patients were identified whose serum had been collected within 5 years of first MS symptom onset. Median follow-up was 17.4 years. Levels of serum NfL were quantified in all 67 MS patients and in 37 matched controls using a digital immunoassay (SiMoA HD-1 Analyzer, Quanterix).

The median baseline NfL level in MS patients was 10.1 pg/mL, which is 38.5% higher than in controls (7.26 pg/mL, P=0.004). Patients reaching Expanded Disability Status Scale (EDSS) ≥4 during follow-up had significantly (73.6%) higher baseline NfL levels than patients with EDSS <4 (P=0.0001). The best cut-off for predicting progression was 7.62 pg/mL. Patients with baseline NfL levels >7.62 pg/mL had a 8.9 times higher risk of developing progressive MS during follow-up (P=0.034; 95% CI 1.2-68.1). Patients in the highest tertile of NfL levels progressed most rapidly (annual EDSS rate 0.16; P=0.004). Patients with baseline NfL levels <7.62 pg/mL had a 4.3 times lower relative risk of significant disability (EDSS score ≥4; P=0.001) and a 7.1 times lower risk of reaching the progressive phase of MS (P=0.054).

1. Thebault S, et al. Abstract S10.008, AAN 2020.

Posted on 10 September, 20205 November, 2020