Implementing NfL in MS in Clinical Practice


An expert neurologist discusses pNfL being utilized outside of clinical trials and implemented into clinical practice for the treatment of MS.

Bruce Hughes, MD: Regarding the future of NfL [neurofilament light chain] and its use in multiple sclerosis, I’m more excited about its potential for monitoring patients, assessing disability progression, and predicting disability progression. It also assesses the response to immunomodulatory treatments, rather than its benefit in assisting us with diagnostics of the disease process, which isn’t as exciting. As far as monitoring patients, it’s much less expensive than performing MRI scans, and it’s much more reproducible than, say, OCT [optical coherence tomography]. I hope it will soon build the data to play a role in our day-to-day management of patients with multiple sclerosis.

Most serum NfL assessments are being done in the setting of clinical trials. There are companies that will run serum NfL levels for your patients, but these aren’t covered by insurance, to my knowledge. They’re not terribly expensive. The fact that they don’t have great insurance coverage is a challenge of getting wider utility.

The hope for NfL in clinical practice is that it will help us stratify our higher-risk patients who need to be on more highly efficacious therapies from the get-go vs patients who may have a potential for a mild disease course and may not need to be on more risky immunotherapies. We’d also like to monitor patients to determine if they’re achieving the response to the therapy that we have them taking. Are they attaining what we want, not just clinically or radiographically how the MRI scan is doing but also a serum biomarker. This would give us more confidence that the therapy we’re on is going to translate to best outcome for this patient decades later.

Transcript edited for clarity

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