Yaldizli, Ozgur and Benkert, Pascal and Achtnichts, Lutz and Bar-Or, Amit and Bohner-Lang, Viviane and Bridel, Claire and Comabella, Manuel and Findling, Oliver and Disanto, Giulio and Finkener, Sebastian and Gobbi, Claudio and Granziera, Cristina and Herwerth, Marina and Hoepner, Robert and Horakova, Dana and Kamber, Nicole and Khalil, Michael and Kunz, Philipp and Lalive, Patrice and Linker, Ralf and Lorscheider, Johannes and Muller, Stefanie and Oechtering, Johanna and Pettypool, Victoria and Piehl, Fredrik and Pot, Caroline and Roth, Patrick and Theaudin, Marie and Tintore, Mar and Tur, Carmen and Uffer, Denis and Uginet, Marjolaine and Vehoff, Jochen and Wiendl, Heinz and Ziemssen, Tjalf and Zecca, Chiara and Salmen, Anke and Leppert, David and Derfuss, Tobias and Kappos, Ludwig and Hemkens, Lars G. and Janiaud, Perrine and Kuhle, Jens (2025) Personalized treatment decision algorithms for the clinical application of serum neurofilament light chain in multiple sclerosis: A modified Delphi Study. MULTIPLE SCLEROSIS JOURNAL, 31 (8). pp. 932-943. ISSN 1352-4585, 1477-0970
Full text not available from this repository. (Request a copy)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.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | OCRELIZUMAB; TERIFLUNOMIDE; CONSENSUS; PLACEBO; TRIAL; personalized treatment strategies; serum neurofilament light chain; Delphi study; escalation; de-escalation |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Neurologie |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 24 Mar 2026 13:13 |
| Last Modified: | 24 Mar 2026 13:13 |
| URI: | https://pred.uni-regensburg.de/id/eprint/68060 |
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