Access to Biomarkers in MS


Bruce Hughes, MD, comments on the current use and access to biomarkers in MS management, as well as sharing how NfL is being used in clinical practice presently.

Bruce Hughes, MD: As far as the use of serum biomarkers in routine clinical practice, the biggest challenge still comes from the lack of large prospective clinical trials to give us a standardization about what levels are acceptable at what age, what therapy a patient is taking, and when a change in levels is actionable or not actionable. We need to build a more standardized approach with larger prospective clinical trials, which are underway. That will hopefully come to fruition in the next few years and be a game changer in how we manage our patients with multiple sclerosis moving forward.

In addition to NfL [neurofilament light chain], there are several other markers—dozens when you look at it—and some that are more easily attainable than others. There are companies that will run not just serum NfL for you but the whole array of other markers so we can figure out their role. Serum NfL has more studies behind it in utility in multiple sclerosis, but that’s not to say that these other biomarkers might not have a role. I’m most excited about 1 called serum glial fibrillary acidic protein, or serum GFAP, as a marker. There are more recent studies published just this year comparing GFAP as a biomarker of a disease progression head-to-head against NfL in patients with multiple sclerosis. It looks quite exciting and potentially comparable.

With presentations in Boston [at the American Academy of Neurology Annual Meeting], the excitement with the serum biomarkers is the potential role of NfL in monitoring patients who have the “smoldering MS.” This is a new type of multiple sclerosis in which patients have progression in the absence of relapse activity. In this category of patients, standard 1.5 or 3 Tesla magnet MRI scans as a biomarker are woefully inadequate. My hope is that in that patient population, the NfL and these other serum biomarkers may have a much greater and more helpful utility in managing our patients.

As far as enhanced care, I’m not certain of the utility in wide-scale use of serum neurofilament light chain. Strategically, it has more utility in multiple sclerosis centers. We’re not quite there yet. I don’t think widespread is quite ready for prime-time use in day-to-day clinical practice, but I hope we’re at the cusp and that will soon change.

Transcript edited for clarity

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