Higher serum neurofilament light chain (sNfL) levels during periods of active inflammation predicted reduced grey matter volume, deep grey matter volume, and cortical thickness 10 years later in patients with relapsing-remitting multiple sclerosis (RRMS), according to a new study published in the Journal of Neurology, Neurosurgery & Psychiatry.

The researchers also found an association between higher levels of sNfL and increased disability as measured by the dominant hand 9-Hole Peg Test (9-HPT).

“As long-term atrophy progression in patients with RRMS seems to be driven by focal inflammatory damage, measuring sNfL levels during relapses may be a way to quantify the extent of ongoing axonal injury, possibly indicating the risk of future disease progression,” the authors said. “This added information may support clinicians in subsequent monitoring and treatment decisions.”

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Increased levels of sNfL during active inflammation have already been demonstrated to reflect acute axonal damage, and have been used to monitor progression and treatment response in patients with MS.

Here, the research team investigated the ability of sNfL levels to predict disability and grey matter atrophy after 10 years by following 92 patients with RRMS from the 24-month multicenter ω-3 Fatty Acid Treatment in Multiple Sclerosis (OFAMS) study, during which sNfL levels were periodically assessed and recorded.

The patients received routine treatment and monitoring between the OFAMS Study and the 10-year follow-up visit, at which time MRI imaging was performed. A total of 85 patients participated in the 10-year follow-up visit, and 78 of them had sNfL serum samples available for analysis. Overall average sNfL levels did not predict particular outcome measures in the patients.

However, higher mean inflammatory sNfL levels did predict reduced grey matter volume and cortical thickness and higher disability scores on the 9-HPT. Thus, the results further reinforce the ability of sNfL levels to serve as a robust biomarker of disease activity and progression in patients with MS.   


Lie IA, Kaçar S, Wesnes K, et al. Serum neurofilament as a predictor of 10-year grey matter atrophy and clinical disability in multiple sclerosis: a longitudinal study. J Neurol Neurosurg Psychiatr. Published online June 1, 2022. doi:10.1136/jnnp-2021-328568