Plasma determination of neurofilaments as biomarkers in multiple sclerosis: conclusions of the EMotion Forum

Introduction. In the management of multiple sclerosis (MS) there is still a need to identify biomarkers of disease progression, and clinical and subclinical activity. Among them, determination of neurofilament light chain plasma levels (Nfl-PM) has shown a possible correlation with clinical course and assessment of therapeutic response in MS patients. However, the determination of Nfl-PM has to overcome several obstacles that hinder its integration into healthcare practice, such as the absence of normalised values and standardised protocols. Aim. This article has two main aims: a) to review the evidence on the usefulness of Nfl in clinical practice as biomarkers of neurodegeneration and inflammation in MS, and b) to pool the conclusions from a forum of MS experts gathered to discuss the usefulness and applicability of NfL-PM determination in Spain (EMotion Forum 2020). Development. Nfl-PM seems particularly useful in determining subclinical activity in MS and offers the possibility of identifying populations at risk of developing MS, such as cases of radiologically isolated syndrome. Issues such as the monitoring of induction disease-modifying drugs or the assessment of suboptimal responses for the withdrawal of ineffective disease-modifying drugs should be considered. Conclusions. The experts agreed on the diagnostic and prognostic potential of Nfl-PM determination and that its usefulness in MS can contribute to the general development of the technique.

Automated summary

Nfl-PM shows potential in determining subclinical activity in MS and identifying populations at risk of developing the disease, but integration into healthcare practice faces obstacles such as the lack of normalized values and standardized protocols.