Abstract
BackgroundNeurofilament light chain (NfL) is an attractive biomarker of disease activity and progression in MS, but there is a lack in long-term prognostic data.ObjectiveTo test the long-term clinical and radiological prognostic value of cerebrospinal fluid (CSF)-NfL among newly diagnosed patients with MS.MethodsNewly diagnosed MS patients where followed prospectively with baseline CSF-NfL and repeated MRI and clinical assessments for up to 10 years. Associations between baseline CSF-NfL and longitudinal MRI and clinical assessments were found by Generalized Estimating Equations analysis.ResultsForty-two participants were included. CSF-NfL at baseline was significantly associated with the rate of atrophy in globus pallidus (p = 0.009) and hippocampus (p = 0.001) as evaluated by MRI. Baseline volumes of thalamus (β −0.33; 95% CI −0.57 to −0.10, p = 0.006), T1 (β 0.28; 95% CI 0.11 to 0.44, p = 0.001) and T2 (β 0.16; 95% CI 0.04 to 0.27, p = 0.008) lesions and baseline levels of CSF-NfL (β 0.9; 95% CI 0.3 to 1.5, p = 0.002) significantly predicted EDSS worsening over 10 years. Baseline CSF-NfL gave a comparable prediction to the best MRI volumetric predictors.ConclusionCSF-NfL predicted the clinical and radiological course of newly diagnosed patients with MS over a 10-year period, underlining its prognostic role.
Highlights
Multiple sclerosis (MS) is the leading inflammatory disorder of the central nervous system (CNS) among young adults worldwide, with an escalating prevalence.[1]
17% were started on disease-modifying treatment (DMT) at baseline, which had increased to 68% at 10-year follow-up (Table 1)
Association between baseline cerebrospinal fluid (CSF)-Neurofilament light chain (NfL) and long-term magnetic resonance imaging (MRI) brain atrophy When adjusting for age at baseline, sex, and disease duration we found significant CSF-NfL-dependent slopes for volumes of globus pallidus (β −0.20; 95% confidence intervals (CI) −0.35 to −0.05, p = 0.009) and hippocampus (β −0.32; 95% CI −0.50 to −0.14, p = 0.001), for both of which higher CSF-NfL predicted a higher rate of atrophy (Table 3)
Summary
Multiple sclerosis (MS) is the leading inflammatory disorder of the central nervous system (CNS) among young adults worldwide, with an escalating prevalence.[1]. Neurofilament light chain (NfL) is an attractive biomarker of disease activity and progression in MS, but there is a lack in long-term prognostic data. Objective: To test the long-term clinical and radiological prognostic value of cerebrospinal fluid (CSF)NfL among newly diagnosed patients with MS. Methods: Newly diagnosed MS patients where followed prospectively with baseline CSF-NfL and repeated MRI and clinical assessments for up to 10 years. Associations between baseline CSF-NfL and longitudinal MRI and clinical assessments were found by Generalized Estimating Equations analysis. CSF-NfL at baseline was significantly associated with the rate of atrophy in globus pallidus (p = 0.009) and hippocampus (p = 0.001) as evaluated by MRI. Conclusion: CSF-NfL predicted the clinical and radiological course of newly diagnosed patients with MS over a 10-year period, underlining its prognostic role
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