The following is a summary of “Association of serum glial fibrillary acidic protein with progression independent of relapse activity in multiple sclerosis,” published in the April 2024 issue of Neurology by Rosenstein et al.

Relapsing-remitting multiple sclerosis (RRMS) often involves subtle worsening, even with effective treatments, highlighting the challenge of progression independent of relapse activity (PIRA).

Researchers conducted a prospective study exploring associations between body fluids, imaging markers, and PIRA in patients with RRMS.

They followed 104 patients with early RRMS for 60 months. Patients were newly diagnosed and previously untreated. They defined PIRA using a composite score involving the disability status scale, 9-hole peg test, timed 25-foot walk test, and symbol digit modalities test. Eleven body fluid and imaging biomarkers were assessed at baseline, along with serum neurofilament light (sNfL) and glial fibrillary acidic protein (sGFAP) levels annually after that. Investigated the association of baseline biomarkers with PIRA using multivariable logistic regression models adjusting for clinical and demographic factors. Examined longitudinal serum biomarker dynamics using mixed effects models.

The results showed that only sGFAP was significantly higher in PIRA patients at baseline, with a median (IQR) of 73.9 (60.9–110.1) vs. 60.3 (45.2–79.9) in non-PIRA patients (P=0.01). A cut-off of sGFAP > 65 pg/mL had a sensitivity of 68% and specificity of 61% to detect patients at greater risk of PIRA. In a multivariable logistic regression, sGFAP > 65 pg/mL was associated with a 4.3-fold higher OR of developing PIRA (95% CI 1.44–12.86, P=0.009). Repeated sGFAP measurements showed that patients who developed PIRA during follow-up had consistently higher levels than stable patients (P<0.001).

Investigators concluded that measuring sGFAP levels at the beginning and during treatment could help identify early patients with RRMS at risk of disability progression regardless of relapse activity.

Source: link.springer.com/article/10.1007/s00415-024-12389-y