Brain | June 28, 2021

Bittner S, Oh J, Havrdová EK, Tintoré M and Zipp F

Brain : a journal of neurology. 2021

DOI: https://doi.org/10.1093/brain/awab241

Abstract

Multiple sclerosis is a highly heterogeneous disease and the detection of neuroaxonal damage as well as its quantification is a critical step for patients. Blood-based neurofilament light chain (sNfL) is currently under close investigation as an easily accessible biomarker of prognosis and treatment response for multiple sclerosis patients. There is abundant evidence that sNfL levels reflect ongoing inflammatory-driven neuroaxonal damage (e.g. relapses or MRI disease activity) and that sNfL levels predict disease activity over the next few years. In contrast, the association of sNfL with long-term clinical outcomes or its ability to reflect slow, diffuse neurodegenerative damage in multiple sclerosis is less clear. However, early results from real-world cohorts and clinical trials using sNfL as a marker of treatment response in multiple sclerosis are encouraging. Importantly, clinical algorithms should now be developed that incorporate the routine use of sNfL to guide individualized clinical decision-making in people with multiple sclerosis, together with additional fluid biomarkers and clinical and MRI measures. Here, we propose specific clinical scenarios where implementing sNfL measures may be of utility, including, among others: initial diagnosis, first treatment choice, surveillance of subclinical disease activity and guidance of therapy selection.