BACKGROUND: The disease-modifying therapies (DMTs) in relapsing-remitting multiple sclerosis (RRMS) vary in their mode of action and when therapies are changed, the consequences on inflammatory and degenerative processes are largely unknown.
OBJECTIVE: We investigated the effect of switching from other DMTs to fingolimod on cerebrospinal fluid (CSF) biomarkers.
METHODS:43 RRMS patients were followed up after 4-12 months of fingolimod treatment. Concentrations of C-X-C motif chemokine 13 (CXCL13), chemokine (C-C motif) ligand 2 (CCL2), chitinase-3-like protein 1 (CHI3L1), glial fibrillary acidic protein (GFAP), neurofilament light protein (NFL), and neurogranin (NGRN) were analyzed by enzyme-linked immunosorbent assay (ELISA), while chitotriosidase (CHIT1) was analyzed by spectrofluorometry.
RESULTS: The levels of NFL, CXCL13, and CHI3L1 decreased (p < 0.05) after fingolimod treatment. Subgroup analysis revealed a reduction in NFL (p < 0.001), CXCL13 (p = 0.001), CHI3L1 (p < 0.001), and CHIT1 (p = 0.002) in patients previously treated with first-line therapies. In contrast, the levels of all analyzed biomarkers were essentially unchanged in patients switching from natalizumab.
CONCLUSION: We found reduced inflammatory activity (CXCL13, CHI3L1, and CHIT1) and reduced axonal damage (NFL) in patients switching from first-line DMTs to fingolimod. Biomarker levels in patients switching from natalizumab indicate similar effects on inflammatory and degenerative processes. The CSF biomarkers provide an additional measure of treatment efficacy.
You have heard of chitinase from NDG and this is another study suggesting it has some biomarker like activity and you all know about neurofilament as a surrogate maker of nerve damage and in this study it drops when you go from people failing first line DMT, i.e. CRAB drugs, and you are put on a highly active second line treatment. Another example where it is clear that that too much inflammation = BAD and drugs that put a halt to this can save brain. Are you willing to have a lumbar puncture to find this out?
I think the answer is no….However you can reduce those headaches if you use atraumatic needles and ultrasound guidance.
If you are on effective DMT your NFL level will drop can we drop this further….if you want to find out and are willing to try a neuroprotectant on top of your DMT you could please check out the PROXIMUS Study (CLICK HERE)