Plasma biomarkers in multiple sclerosis: a treatment comparison analysis of highly efficacious versus moderately efficacious disease modifying therapies

Multiple sclerosis (MS) is an immune-mediated demyelinating disease of the central nervous system. Clinicians may employ a “treat-to-target” (escalating disease modifying therapy (DMT) as needed) approach, or an “early intensive” (upfront treatment with highly efficacious medications at diagnosis) approach. Current evidence suggests that early aggressive control of relapsing activity results in less Central Nervous System (CNS) injury and a better long-term prognosis. Several biomarkers are used clinically to aid in the diagnosis of MS, and newly validated biomarkers such as cerebrospinal fluid (CSF) and serum neurofilament light chain (NfL) and glial fibrillary acidic protein (GFAP) are emerging as important diagnostic, prognostic, and therapeutic response biomarkers, especially in relapsing-remitting MS (RRMS). This study utilized a combined retrospective and prospective longitudinal active-comparator cohort study design to determine whether utilization of an “early-intensive” therapeutic approach resulted in significant differences in plasma NfL and GFAP concentrations. A total of 12 patients on high-efficacy DMT and 9 patients on moderately efficacious DMT were recruited for this analysis. Secondary outcomes included plasma C-X-C Motif Chemokine Ligand 13 (CXCL13), as well as relevant T and B immune cell subsets, including CD4+, CD8+, CD19+ immune cells, among others.