Plasma Neurofilament Light Chain in relapsing remitting multiple sclerosis patients: a new NEDA parameter?

The treatment of relapsing remitting multiple sclerosis (RRMS), which affects mainly young people, with severity evolution to motor disability in most patients, has been remarkable impacted in the last twenty-five years by the advancement of knowledge about the pathophysiology, new therapeutic targets, early diagnosis criteria and monitoring of treatment response.The search for disease follow-up biomarkers and treatment has been demonstrated by new tools and the concept of precision medicine. RRMS treatment has been impacted by a new era of disease-modifying drugs (DMD), early diagnosis and treatment, and the goal of NEDA, or no evidence of disease activity, which includes disability scores, burden of inflammatory and degenerative lesions in MRI, therapeutic failure and serum biomarker level. The arsenal of DMD, with a scale to less efficacy treatment onset in the majority of the protocols need to be review in face of these new concepts and new technologies tools. Methods:We analyzed by single molecule array the NfL plasma level in RRMS naïve patients and patients which switched from “first line” therapy to moderate-high efficacy DMD. Results: We include 17 of 250 RRMS patients. The mean age of RRMS patients was 40.64 years and healthy control mean age was 40.66 years. pNfL level RR patients without DMD and during first line therapy was 13.9 pg/mL and after the switch or during treatment with moderate-high DMD it decreases to 7 pg/mL, similar to healthy control which was 6.7 pg/mL. Conclusion:Significant difference between NfL levels before and after high efficacy treatment (p<0.05) seems to be according to the phase III clinical trials results which showed the impact of new drugs in both efficacy and control of NFL levels. The role of NFL can contribute on treatment management, especially in the monitoring of the therapeutic failure aiming to impact early on the course of MS disability.