Baseline neurofilament levels in cerebrospinal fluid do not correlate with long-term prognosis in multiple sclerosis

Multiple Sclerosis (MS) is the most common autoimmune disease of the central nervous system. Up to this day, no single accurate prognostic biomarker has been established in this disease. Neurofilaments are neuronal scaffold proteins released upon axonal damage and have gained attention as potential biomarkers in MS.

Neurofilament light-chain (NfL) levels were measured in the cerebrospinal fluid (CSF) of 83 MS patients at their first hospital admission. The patients were longitudinally followed up and EDSS assessments (MS disability) were performed. MSSS scores (MS severity) were also calculated. For disability, patients were allocated to a benign (EDSS≤3) and non-benign course (EDSS>3), and for severity, to benign, moderate, and severe disease courses (benign: 0-1.999, moderate: 2-6.999, severe: 7-10).

NfL levels ranged between 185.8 and 24,440.0 ng/dl (median=995.8 ng/dl, mean=2032.9 ng/dl ±3107.8). The mean follow-up was 12.3 years (±6.7), ranging between 2 and 41 years (median=11 years). No significant association was found between NfL levels and age of onset (p = 0.858), disability (OR benign vs. non-benign: 0.916, p = 0.725), or severity (OR moderate vs. benign: 1.077, p = 0.791, OR severe vs. benign: 1.163, p = 0.642). A significant association was found between older age of onset and disability (OR benign vs. non-benign: 1.073, p = 0.005), and severity (OR moderate vs. benign: 1.063, p = 0.039, OR severe vs. benign: 1.122, p = 0.001).

CSF NfL do not seem to be the ideal prognostic marker in MS. More research in this direction, with large follow-up periods, is needed to confirm our findings.