Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Katerinska 30, 120 00 Prague, Czech Republic.
Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic/CORe, Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia.
Mult Scler. 2021 Nov;27(13):2001-2013. doi: 10.1177/13524585211047977. Epub 2021 Oct 6.
The added value of neurofilament light chain levels in serum (sNfL) to the concept of no evidence of disease activity-3 (NEDA-3) has not yet been investigated in detail.
To assess whether combination of sNfL with NEDA-3 status improves identification of patients at higher risk of disease activity during the following year.
We analyzed 369 blood samples from 155 early relapsing-remitting MS patients on interferon beta-1a. We compared disease activity, including the rate of brain volume loss in subgroups defined by NEDA-3 status and high or low sNfL (> 90th or < 90th percentile).
In patients with disease activity (EDA-3), those with higher sNFL had higher odds of EDA-3 in the following year than those with low sNFL (86.5% vs 57.9%; OR = 4.25, 95% CI: [2.02, 8.95]; = 0.0001) and greater whole brain volume loss during the following year (β = -0.36%; 95% CI = [-0.60, -0.13]; = 0.002). Accordingly, NEDA-3 patients with high sNfL showed numerically higher disease activity (EDA-3) in the following year compared with those with low sNfL (57.1% vs 31.1%).
sNfL improves the ability to identify patients at higher risk of future disease activity, beyond their NEDA-3 status. Measurement of sNfL may assist clinicians in decision-making by providing more sensitive prognostic information.
血清神经丝轻链（sNfL）水平对无疾病活动-3（NEDA-3）概念的附加价值尚未详细研究。
评估 sNfL 与 NEDA-3 状态相结合是否可以提高对下一年疾病活动风险较高患者的识别能力。
我们分析了 155 例接受干扰素 β-1a 治疗的早期复发缓解型多发性硬化症患者的 369 份血样。我们比较了疾病活动度，包括根据 NEDA-3 状态和 sNfL 高低（>第 90 百分位数或<第 90 百分位数）定义的亚组中的脑容量损失率。
在有疾病活动（EDA-3）的患者中，sNFL 较高的患者在随后的一年中发生 EDA-3 的可能性高于 sNFL 较低的患者（86.5%比 57.9%；OR=4.25，95%CI：[2.02，8.95]；=0.0001），并且在下一年中脑总体积损失更大（β=-0.36%；95%CI：[-0.60，-0.13]；=0.002）。因此，sNfL 较高的 NEDA-3 患者在下一年的疾病活动（EDA-3）比 sNfL 较低的患者更高（57.1%比 31.1%）。
sNfL 提高了识别未来疾病活动风险较高患者的能力，超出了其 NEDA-3 状态。sNfL 的测量可以通过提供更敏感的预后信息来帮助临床医生做出决策。
