Multiple Sclerosis News TodayBlood Levels of Key Protein May Help Predict MS Progression

ℹ️ Observational Association Only Evidence

Researchers examined whether serum neurofilament light chain (NfL) could improve prediction of clinical and radiologic progression beyond MRI in early multiple sclerosis. The analysis included 262 participants from the REFLEX trial and REFLEXION extension who initiated interferon beta-1a and were followed for five years. Higher baseline age- and BMI-adjusted NfL levels were associated with greater baseline lesion burden, subsequent brain atrophy, and progression to clinically definite MS. However, associations with MS conversion and brain atrophy were no longer statistically significant after adjustment for baseline MRI measures and demographic factors, suggesting that baseline NfL largely captured inflammatory disease activity already reflected by MRI.

Clinical Considerations

• Approximately 40% of the 262 participants converted to clinically definite MS during five years of follow-up.
• Higher baseline z-scored NfL was associated with greater MRI lesion burden, greater subsequent brain atrophy, and higher likelihood of conversion to clinically definite MS before adjustment for imaging and demographic variables.
• After baseline MRI measures, age, and sex were incorporated, baseline NfL lost its independent predictive association with conversion and brain atrophy.
• The findings suggest baseline NfL may have greater prognostic utility when MRI information is unavailable rather than providing substantial incremental information beyond imaging.
• Most longitudinal changes in NfL were not associated with clinical progression measures.
• One signal emerged later in treatment: increasing NfL during the second treatment year was associated with faster brain atrophy during the subsequent three years.
• The cohort consisted of patients with early disease treated with interferon beta-1a, which should be considered when assessing applicability to contemporary MS populations and treatment strategies.

Practice Applications

• Interpret serum NfL as complementary to, rather than a replacement for, MRI when assessing disease activity and prognosis in early MS.
• Recognize that elevated baseline NfL may largely reflect inflammatory disease activity already detectable by MRI.
• Avoid assuming that an elevated baseline NfL independently predicts long-term progression when imaging and demographic information are available.
• Monitor emerging longitudinal evidence to determine whether serial NfL trajectories offer clinically meaningful information beyond single measurements.
• Consider NfL especially relevant to research on blood-based monitoring when MRI is unavailable or impractical, while recognizing that this study did not validate an NfL-directed clinical strategy.