New Biomarker Adds Insight Beyond MRI Scans
A study conducted at the Multiple Sclerosis Centre of Catalonia (Cemcat) has found that tracking levels of light neurofilament (NfL) in the blood helps identify ongoing disease activity in people with multiple sclerosis (MS) even when standard tests show no signs. NfL is a protein released when nerve cells are damaged, and its presence in the bloodstream can be measured with a blood test. The research, published in the journal Neurology, shows that patients whose NfL levels do not decrease during the first year of treatment are about three times more likely to experience disease activity in the second year. This association held true even among patients who met NEDA-3 criteria after one year, meaning no relapses, no disability progression, and no new lesions on magnetic resonance imaging (MRI). The findings suggest that biological disease activity may persist even when clinical and radiological evaluations suggest stability.
Complementary Tool for Personalised Monitoring
Monitoring neurofilament provides us with an additional dimension to the information we obtain from clinical evaluation and magnetic resonance imaging,
Dr. Georgina Arrambide, neurologist at Cemcat and principal investigator at the Vall d’Hebron Research Institute (VHIR), explained. The study used a standardised z-score to track NfL levels, adjusting for factors like age and body mass index to allow more accurate comparisons over time. Researchers analysed data from individuals with relapsing-remitting MS on various disease-modifying therapies. Even among patients with favourable scores on established monitoring systems like the Rio score, lack of NfL reduction still predicted higher risk of future activity. This suggests NfL monitoring could refine risk assessment without replacing current tools.
MRI remains essential for assessing structural changes in MS. However, the authors suggest that unexpected NfL trends could help identify patients who may benefit from additional scans. The study noted limitations: the ability of NfL to predict later activity was moderate (area under the curve ~0.63), and the predictive value weakened when looking beyond the second year. Therefore, repeated measurements over time are recommended. NfL is not proposed as a standalone decision-making tool but as a complement to clinical and radiological data, supporting more personalised monitoring, especially for patients who appear stable but may still have underlying disease activity.
Sources: Vall d'Hebron - News, vallhebron.com, vhir.vallhebron.com.
