Sistema de Salut de Catalunya
Institut Català de la Salut
[Yaldizli Ö] Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland. Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel, University of Basel, Basel, Switzerland Neurologic Clinic and Policlinic, MS Centre, University Hospital Basel, Basel, Switzerland. Translational Imaging in Neurology Basel, Department of Medicine and Biomedical Engineering, University Hospital Basel, University of Basel, Basel, Switzerland. [Benkert P] Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland. [Achtnichts L] Neurozentrum Oberaargau, Langenthal, Switzerland. [Bar-Or A] Center for Neuroinflammation and Experimental Therapeutics and Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. [Bohner-Lang V] Patient Consultant, Basel, Switzerland. [Bridel C] Translational Biomarker Research Group, Department of Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland. [Comabella M, Tintore M, Tur C] Centre d’Esclerosi Múltiple de Catalunya (CEMCAT), Barcelona, Spain. Vall d’Hebron Hospital Universitari, Barcelona, Spain
Vall d'Hebron Barcelona Hospital Campus
2025-09-19T11:55:18Z
2025-09-19T11:55:18Z
2025-07
De-escalation; Personalized treatment strategies; Serum neurofilament light chain
Desescalada; Estrategias de tratamiento personalizadas; Cadena ligera de neurofilamentos sérica
Desescalada; Estratègies de tractament personalitzades; Cadena lleugera de neurofilaments sèrics
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.
This study is part of the MultiSCRIPT trial supported by the Swiss National Science Foundation as part of the Investigator Initiated Clinical Trial program (grant no. 33IC30_205806/1).
Article
Versió publicada
Anglès
Mètode Delphi; Esclerosi múltiple - Tractament; Medicina personalitzada; Filaments citoplasmàtics; ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Therapeutics::Precision Medicine; CHEMICALS AND DRUGS::Amino Acids, Peptides, and Proteins::Proteins::Amino Acids, Peptides, and Proteins::Proteins::Nerve Tissue Proteins::Neurofilament Proteins; DISEASES::Nervous System Diseases::Autoimmune Diseases of the Nervous System::Demyelinating Autoimmune Diseases, CNS::Multiple Sclerosis; Other subheadings::Other subheadings::Other subheadings::/drug therapy; INFORMATION SCIENCE::Information Science::Systems Analysis::Delphi Technique; TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::terapéutica::medicina de precisión; COMPUESTOS QUÍMICOS Y DROGAS::aminoácidos, péptidos y proteínas::proteínas::aminoácidos, péptidos y proteínas::proteínas::proteínas del tejido nervioso::proteínas de neurofilamentos; ENFERMEDADES::enfermedades del sistema nervioso::enfermedades autoinmunitarias del sistema nervioso::enfermedades autoinmunes desmielinizantes del SNC::esclerosis múltiple; Otros calificadores::Otros calificadores::Otros calificadores::/farmacoterapia; CIENCIA DE LA INFORMACIÓN::Ciencias de la información::análisis de sistemas::técnica Delfos
SAGE Publications
Multiple Sclerosis Journal;31(8)
https://doi.org/10.1177/13524585251335466
Attribution 4.0 International
http://creativecommons.org/licenses/by/4.0/
Articles científics - CEMCAT [136]
Articles científics - HVH [3396]
