Neurofilament Light Prevalence Predicts Disease Progression in RRMS

In a recent study presented at the European Academy of Neurology Annual Meeting held in Lisbon, Portugal, from June 16 to 19, researchers found that the levels of neurofilament light chain (NfL) can be a reliable predictor of disease worsening in relapsing-remitting multiple sclerosis (RRMS) patients.

NfL is a protein expressed by neurons, and their progressive degeneration in MS promotes the release of NfL into cerebral spinal fluid and blood. In fact, there is increasing evidence that suggests that NfL levels are specifically elevated in cerebrospinal fluid and blood of MS patients.

Previous studies have suggested that evaluating NfL levels can be a valuable tool in monitoring MS disease progression and response to treatment, rather than brain magnetic resonance imaging (MRI) scans. In this study, researchers investigated the prognostic potential of blood NfL levels by analyzing blood samples from RRMS patients in the phase 3 FREEDOMS and TRANSFORMS trials.

In the FREEDOMS trial, patients were randomized to receive fingolimod (Gilenya) or a placebo; concurrently in the TRANSFORMS trial, researchers compared the efficacy of fingolimod with interferon beta-1a (Avonex), an FDA-approved MS therapy. NfL was measured at the start of the trial, and again at months 6, 12, 24, and 120.

The studies demonstrated that increased levels of NfL could predict the time to first relapse, the accumulation of T2 lesions in the brain, and the annual rate of brain atrophy. In addition, researchers found that the levels of NfL detected were associated with certain markers of disease disability and disease progression. After 10 years of treatment, NfL blood levels were reduced from 30.6 to 18.4pg/mL.

The researchers noted that, “Our data support the value of plasma NfL as a mid to long-term prognostic biomarker of disease evolution and progression in RRMS. The reduction of NfL levels achieved by fingolimod treatment was sustained over 10 years.”

Reference

Kuhle J, Cohen JA, Kropshofer H, et al. Long-term prognosis of disease evolution and evidence for sustained fingolimod treatement effect by plasma neurofilament light in RRMS patients. Presented at the European Academy of Neurology Annual Meeting June 16-19, 2018; Lisbon, Portugal. AB0114. onlinelibrary.wiley.com/doi/epdf/10.1111/ene.13698