MS disability: plasma neurofilament light chain level predicts risk for worsening

  • Neurology
  • 20 may. 2020

  • de Susan London
  • Clinical Essentials
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Takeaway

  • Patients with multiple sclerosis (MS) who have higher plasma levels of neurofilament light chain protein may be at increased risk for disability progression.

Why this matters

  • Accurate prediction of clinical course using such testing can help inform counseling, treatment, and planning.
  • Editorial: the findings confirm the prognostic value of this biomarker, but some questions remain, including how to reconcile assays and establish global cutoff values.  

Key results

  • Baseline median plasma neurofilament light chain level was 52% higher in patients with MS vs unaffected participants (11.4 vs 7.5 pg/mL; P<.001>
  • With median 5-year follow-up, a high biomarker level using various age-stratified percentile cutoffs (80%, 95%, 99%) was linked to increased adjusted rates of:
    • Expanded Disability Status Scale (EDSS) worsening within a year: 1.40-1.65.
    • Reaching sustained EDSS score of 3.0: 1.50-1.55.
    • Reaching sustained EDSS score of 4.0: 1.46-1.60.
    • All P<.001.>
  • No consistent significant associations were seen for reaching sustained EDSS score of 6.0, conversion to secondary progressive MS.

Study design

  • Longitudinal cohort study of 4385 adult patients in Sweden with MS (predominantly relapsing-remitting) and 1026 randomly selected population-based sex- and age-matched unaffected participants.
  • Main outcomes: disability progression.
  • Funding: Swedish Research Council; Biogen; others.

Limitations

  • Variability, overlap of levels between patients and unaffected participants and by MS subtype.
  • Inability to account for comorbidities.
  • No long-term MRI data.
  • Small number of patients reaching disability milestones.