Serum neurofilament light chain (sNfL) levels have been proposed as a biomarker of the clinical activity, disability progression, and response to treatment of people with multiple sclerosis (PwMS); however, questions remain about its implementation in clinical practice. Ocrelizumab (OCR) has proven effective in improving clinical and radiological outcomes and reducing sNfL levels. This real-life study followed the sNfL levels of 30 PwMS treated for 12 months with OCR and evaluated the usefulness of this biomarker for their short-term prognosis, considering expanded disability status scale (EDSS), annualized relapse rate (ARR), radiological activity, and NEDA-3 values. OCR reduced ARR in 83% of PwMS and radiological activity in 80%. EDSS was maintained, while NEDA-3 was achieved in 70% at 12 months. OCR produced an early reduction in sNfL levels (at 3 months). At baseline, greater MRI-evaluated radiological activity was associated with higher sNfL levels. sNfL levels over the first 12 months of treatment did not predict a suboptimal response or sustained control of the disease. Longer-term studies are needed to explore the predictive usefulness of sNfL levels in PwMS treated with high-efficacy drugs.

Serum neurofilament light chain (sNfL) levels have been proposed as a biomarker of the clinical activity, disability progression, and response to treatment of people with multiple sclerosis (PwMS); however, questions remain about its implementation in clinical practice. Ocrelizumab (OCR) has proven effective to improve clinical and radiological outcomes and to reduce sNfL levels. This real-life study followed the sNfL levels of 30 PwMS treated for 12 months with OCR and evaluated the usefulness of this biomarker for the short-term prognosis, considering expanded disability status scale (EDSS), annualized relapse rate (ARR), radiological activity, and NEDA-3 values. OCR reduced the ARR in 83% of PwMS and the radiological activity in 80%. Their EDSS was maintained, while NEDA-3 was achieved in 70% at 12 months. OCR produced an early reduction in sNfL levels (at 3 months). At baseline, greater MRI-evaluated radiological activity was associated with higher sNfL levels. sNFL levels over the first 12 months of treatment did not predict a suboptimal response or sustained control of the disease. Longer-term studies are needed to explore the predictive usefulness of sNfL levels in PwMS treated with high-efficacy drugs

Background: Amyloid positron emission tomography (PET) has been proposed as a tool to monitor myelination in multiple sclerosis (MS). We present the first study to include both early and standard phases of amyloid PET in patients with newly diagnosed MS. Methods: Prospective study including patients with newly diagnosed MS (Jan 2023-Feb 2024). Clinical evaluation includes neurological, disability (EDSS) and neuropsychological assessment. Brain MRI, early ¹⁸F-florbetaben (FBB) PET (eFBB; 0–5’, 0-10’ p.i.), and standard FBB PET (sFBB; 90’ p.i.) were acquired. Normal-appearing white matter (NAWM) and damaged (DWM) in MRI were segmented and co-registered with PET images. Results are presented as standardized uptake values (SUV), ratio using cerebellum as the reference region (SUVR) and percentage of change between DWM and NAWM. Results: Twenty patients were included (35.05±10.72 years; 75% women). We found, both “eFBB and sFBB adquistions” a lower mean SUVRmax and SUVRmean and higher mean SUVRmin in DWM compared to NAWM (p<0.001) in all patients. SUV parameters in both DWM and NAWM from eFBB and sFBB PET correlated with the number of relapses and EDSS (r = –0.454 and r = –0.446, respectively; p < 0.05). Additionally, SUVR values in DWM during eFBB correlated with cognitive impairment (SDMT; r = –0.516, p < 0.01), fatigue (MFIS–5; r = –0.450, p < 0.05), and quality of life (EQ-5D; r = –0.490, p < 0.05). Conclusion: Quantitative analysis of dual phase FBB PET demonstrates differential uptake between DWM and NAWM, probably associated with demyelination and neurodegeneration. These preliminary findings suggest that amyloid PET may have predictive value for disease activity and progression, supporting its potential as a biomarker in MS.