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SHR Neuro Cancer Cardio Lipid Metab Microb

Yaldizli, Ö; Benkert, P; Achtnichts, L; Bar-Or, A; Bohner-Lang, V; Bridel, C; Comabella, M; Findling, O; Disanto, G; Finkener, S; Gobbi, C; Granziera, C; Herwerth, M; Hoepner, R; Horakova, D; Kamber, N; Khalil, M; Kunz, P; Lalive, P; Linker, R; Lorscheider, J; Müller, S; Oechtering, J; Pettypool, V; Piehl, F; Pot, C; Roth, P; Théaudin, M; Tintore, M; Tur, C; Uffer, D; Uginet, M; Vehoff, J; Wiendl, H; Ziemssen, T; Zecca, C; Salmen, A; Leppert, D; Derfuss, T; Kappos, L; Hemkens, LG; Janiaud, P; Kuhle, J.
Personalized treatment decision algorithms for the clinical application of serum neurofilament light chain in multiple sclerosis: A modified Delphi Study.
Mult Scler. 2025; 13524585251335466 Doi: 10.1177/13524585251335466
Web of Science PubMed FullText FullText_MUG

 

Co-authors Med Uni Graz
Khalil Michael
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Abstract:
BACKGROUND: Serum neurofilament light (sNfL) chain levels, a sensitive measure of disease activity in multiple sclerosis (MS), are increasingly considered for individual therapy optimization yet without consensus on their use for clinical application. OBJECTIVE: We here propose treatment decision algorithms incorporating sNfL levels to adapt disease-modifying therapies (DMTs). METHODS: We conducted a modified Delphi study to reach consensus on algorithms using sNfL within typical clinical scenarios. sNfL levels were defined as "high" (>90th percentile) vs "normal" (<80th percentile), based on normative values of control persons. In three rounds, 10 international and 18 Swiss MS experts, and 3 patient consultants rated their agreement on treatment algorithms. Consensus thresholds were defined as moderate (50%-79%), broad (80%-94%), strong (≥95%), and full (100%). RESULTS: The Delphi provided 9 escalation algorithms (e.g. initiating treatment based on high sNfL), 11 horizontal switch (e.g. switching natalizumab to another high-efficacy DMT based on high sNfL), and 3 de-escalation (e.g. stopping DMT or extending intervals in B-cell depleting therapies). CONCLUSION: The consensus reached on typical clinical scenarios provides the basis for using sNfL to inform treatment decisions in a randomized pragmatic trial, an important step to gather robust evidence for using sNfL to inform personalized treatment decisions in clinical practice.

Find related publications in this database (Keywords)
personalized treatment strategies
serum neurofilament light chain
Delphi study
escalation
de-escalation
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