Progresssive trials its all sorted or is it?

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Serum neurofilament light as a biomarker in progressive multiple sclerosis.Kapoor R, Smith KE, Allegretta M, Arnold DL, Carroll W, Comabella M, Furlan R, Harp C, Kuhle J, Leppert D, Plavina T, Sellebjerg F, Sincock C, Teunissen CE, Topalli I, von Raison F, Walker E, Fox RJ.Neurology. 2020 Jul 16:10.1212/WNL.0000000000010346

There is an unmet need in multiple sclerosis (MS) therapy for treatments to stop progressive disability. The development of treatments may be accelerated if novel biomarkers are developed to overcome the limitations of traditional imaging outcomes revealed in early phase trials. In January 2019, the International Progressive Multiple Sclerosis Alliance convened a standing expert panel to consider potential tissue fluid biomarkers in MS in general and in progressive MS specifically. The panel focused their attention on neurofilament light chain (NfL) in serum or plasma, examining data from both relapsing and progressive MS. Here, we report the initial conclusions of the panel and its recommendations for further research. Serum NfL (sNfL) is a plausible marker of neurodegeneration that can be measured accurately, sensitively, and reproducibly, but standard procedures for sample processing and analysis should be established. Findings from relapsing and progressive cohorts concur and indicate that sNfL concentrations correlate with imaging and disability measures, predict the future course of the disease, and can predict response to treatment. Importantly, disease activity from active inflammation (i.e. new T2 and gadolinium-enhancing lesions) is a large contributor to sNfL, so teasing apart disease activity from the disease progression that drives insidious disability progression in progressive MS will be challenging. More data is required on the effects of age and comorbidities, as well as the relative contributions of inflammatory activity and other disease processes.

So I terminate this here, but the question is do we buy it? Is blood neurofilament levels the solution? If we do we buy it we pat the people on the back for a job well done.

Does it say we don’t need MRI as it is an indicatory of inflammatory lesion formation

Does it say if you have X level of neurofilament in your blood we know what is going to happen to you in the future

I borrowed this figure of blood neurofilament from another paper but ask what is the predictive value for the majority of red dots?

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