NEW research presented this weekend at the the European Academy of Neurology (EAN) Congress 2025, has confirmed that serum neurofilament light chain (sNfL) is a dynamic and reliable short-term biomarker for predicting relapses in multiple sclerosis, with elevated levels signalling disease activity up to a year before clinical symptoms emerge.
Multiple sclerosis (MS) is a chronic neurological disorder in which the immune system attacks the protective myelin sheath of nerve fibres, leading to progressive neurological impairment. Early detection of disease activity is crucial for timely intervention and improved outcomes, but traditional monitoring methods have limitations in predicting relapses and guiding routine care.
In a retrospective longitudinal study conducted at the Medical University of Graz, researchers analysed data from 162 MS patients, with a mean age of 32.5 years and a median disease duration of just over two years. Each patient had a median of seven serum samples collected over a median follow-up period of 10.4 years. sNfL levels were measured using the Simoa HD-X analyser and adjusted for age and BMI to generate Z-scores. Radiological activity was assessed with 3T MRI scans, and evidence of disease activity (EDA) was defined as clinical relapse, confirmed disability progression, or radiological changes within six months of sampling.
The results showed that sNfL Z-scores were significantly elevated in patients who went on to experience EDA within one year of sampling, but only in samples taken during remission (p<0.001). sNfL levels did not predict disease activity beyond the one-year window. Temporal analysis also revealed that sNfL levels rose sharply at the onset of clinical relapse and remained elevated for up to nine months afterwards, reflecting ongoing neuroaxonal injury and the slow biological clearance of the protein.
These findings highlight the value of sNfL as a sensitive early warning biomarker for short-term relapse risk in MS, especially when measured during periods of clinical remission. For clinical practice, incorporating sNfL monitoring into routine care could help clinicians identify patients at higher risk of imminent disease activity, enabling earlier intervention and more personalised treatment strategies. However, sNfL should be interpreted alongside other clinical and imaging data, as its predictive power is limited to the short term and may be influenced by other factors such as treatment changes or comorbidities.
Reference
Martínez-Serrat M et al. Temporal dynamics of serum neurofilament light chain in MS: A retrospective study in a clinical routine setting. Abstract OPR-079. EAN Congress, 21-24 June, 2025.
