Photo Credit: Grandbrothers
Researchers analyzed whether age and BMI impacted the value of serum neurofilament light chain for predicting demyelinating events in relapsing MS.
In an abstract1 presented at ACTRIMS Forum 2024, researchers investigated whether age and BMI impact the prognostic value of serum neurofilament light chain (sNfL) levels in patients with relapsing MS.
According to previously published data2 from the phase 3 ASCLEPIOS I/II trials, baseline sNfL levels demonstrated good prognostic value for future lesion formation, whole brain atrophy, and regional atrophy in patients with relapsing MS, including patients who were recently diagnosed or treatment-naive.
“Biomarkers that can help to more reliably prognosticate future disease activity based on a standardized test could complement clinical and radiological assessments and would be of high value for decision making in routine clinical practice,” authors of the previous report explained.2 “There is currently an unmet need for a highly standardized, minimally invasive biomarker test, such as sNfL, to stratify diagnosed [patients with relapsing MS] into high- and low-risk groups based on the risk and intensity of anticipated future MS disease activity.”
To build on the initial findings, Anne H. Cross, MD, affiliated with Washington University, and colleagues conducted subgroup analyses of participants in the trials, stratifying patients into different BMI and age groups.
Accounting for Baseline BMI and Age
A total of 1,882 patients aged 18-55 years participated in the ASCLEPIOS I/II trials. Baseline sNfL levels and data on new or enlarging T2 lesions were available for 1,678 patients (89.2%).
“A baseline sNfL cut-off was predefined by the median sNfL value across ASCLEPIOS I/II,” Dr. Cross and colleagues wrote. “Participants were stratified into high (greater than or equal to median [9.3 pg/mL]) and low (less than 9.3 pg/mL) groups, irrespective of treatment received.”
Dr. Cross and colleagues then created and analyzed four participant subgroups:
- BMI less than 24.5 kg/m2
- BMI greater than or equal to 24.5 kg/m2
- Age younger than 38 years
- Age 38 years or older
The researchers used negative binomial regression models to adjust for sNfL group and the interaction between sNfL and BMI/age, and to estimate the lesion rate ratio for high versus low sNfL levels in each subgroup.
sNfL Levels Predict Demyelinating Events
Compared to those with low sNfL levels, participants with high sNfL levels had a higher mean annualized rate of new or enlarging T2 lesions in both the lower BMI (4.04 vs 2.10; RR: 1.92; P<0.001) and higher BMI (4.14 versus 1.66, RR: 2.49; P<0.001) subgroups.
Dr. Cross and colleagues reported similar findings across age subgroups. Participants with high sNfL levels had higher mean annualized rates of new or enlarging T2 lesions in both the younger age (5.68 vs 2.91, RR: 1.95; P<0.001) and older age (2.50 vs 0.94, RR: 2.66; P<0.001) subgroups.
“Baseline sNfL levels were prognostic of future lesion formation irrespective of baseline BMI and age, supporting the use of sNfL as a prognostic biomarker for relapsing multiple sclerosis disease activity,” Dr. Cross and colleagues concluded.
