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Serum neurofilament-light concentration and real-world outcome in MS
Journal of the Neurological Sciences ( IF 4.4 ) Pub Date : 2020-10-01 , DOI: 10.1016/j.jns.2020.117079
Valerie Anderson 1 , Emily Bentley 1 , Sam Loveless 1 , Lucia Bianchi 2 , Katharine E Harding 3 , Ray A Wynford-Thomas 4 , Fady Joseph 3 , Gavin Giovannoni 2 , Sharmilee Gnanapavan 2 , Neil P Robertson 4 , Monica Marta 2 , Emma C Tallantyre 4
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BACKGROUND Prognostication in multiple sclerosis (MS) remains challenging. Biomarkers capable of providing this information at diagnosis would be valuable in shaping therapeutic decisions. Measurement of neurofilament light (NfL) has shown promise in predicting clinical outcomes in established MS, but its ability to predict outcomes in real-world cohorts at diagnosis requires further validation. METHODS We used linear regression to evaluate the relationship between serum NfL (sNfL), measured at the time of diagnosis with short-term (1-year) and medium-term (5-year) clinical outcomes in 164 people with MS from a real-world, population-based cohort. Cox proportional hazards regression was used to analyse the association between sNfL and subsequent hazard of relapse or sustained accumulation of disability (SAD). Analyses were adjusted for age and disease-modifying treatment (DMT). RESULTS sNfL concentration at diagnosis was modestly associated with baseline EDSS score (β = 0.272, 95% CI 0.051 to 0.494, p = 0.016). However, no significant associations were found between baseline sNfL and odds of relapse at 12-months, 5-year EDSS change, or the hazard of relapse or SAD over 5 years follow-up. Dichotomising baseline sNfL according to the median sNfL did not change these findings. CONCLUSIONS sNfL appears to be of limited clinical utility in predicting future irreversible neurological disability in a largely untreated real-world population, and remains insufficiently validated to shape treatment decisions at the time of diagnosis. Further studies may be needed for sNfL to be considered as a prognostic marker in the MS clinic. However the masking effect of DMTs on the natural disease trajectory will continue to pose challenges.

中文翻译:

MS 中血清神经丝光浓度和真实世界的结果

背景 多发性硬化症 (MS) 的预后仍然具有挑战性。能够在诊断时提供这些信息的生物标志物对制定治疗决策很有价值。神经丝光 (NfL) 的测量在预测已确诊 MS 的临床结果方面显示出前景,但其在诊断时预测真实世界队列结果的能力需要进一步验证。方法 我们使用线性回归来评估 164 名 MS 患者在诊断时测量的血清 NfL (sNfL) 与短期(1 年)和中期(5 年)临床结果之间的关系。 -世界,基于人口的队列。Cox 比例风险回归用于分析 sNfL 与随后复发或持续残疾累积 (SAD) 风险之间的关联。分析针对年龄和疾病缓解治疗(DMT)进行了调整。结果 诊断时的 sNfL 浓度与基线 EDSS 评分适度相关(β = 0.272,95% CI 0.051 至 0.494,p = 0.016)。然而,未发现基线 sNfL 与 12 个月时复发的几率、5 年 EDSS 变化或 5 年随访期间复发或 SAD 的风险之间存在显着关联。根据中位数 sNfL 对基线 sNfL 进行二分法并没有改变这些发现。结论 sNfL 在预测大部分未经治疗的现实世界人群中未来不可逆转的神经功能障碍方面的临床效用似乎有限,并且在诊断时仍未充分验证以制定治疗决策。可能需要进一步研究将 sNfL 视为 MS 诊所的预后标志物。
更新日期:2020-10-01
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