Neurological

Kappa-Free Light Chain Index predicts early multiple sclerosis activity

A high index of the κ-free light chain (κ-FLC) can predict early disease activity in multiple sclerosis (MS) and has a prognostic value in comparison to the determination of the oligoclonal band (OCB) restricted by liquor, according to study results in Neurology Neuroimmunology & Neuroinflammation published.

In patients with multiple sclerosis, when to start treatment and whether to use moderately or highly effective disease-modifying therapies are often discussed, leading to the need for biomarkers to predict disease activity.

While the number of lesions with magnetic resonance imaging (MRI) of the brain and OCBs in CSF has some prognostic value, FLC in CSF is emerging as an improved biomarker in MS. To better understand this, a team of researchers conducted a study to determine whether the κ and λ FLC indices can predict early disease activity regardless of demographic, clinical, and MRI characteristics.

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The study examiners included a total of 88 patients (mean age 33 years; 68% women) in the analysis with prospective follow-up over 3 to 4 years for disease-modifying therapy. OCBs were positive in 79 of the patients.

At follow-up (median 47 months), 38 patients had a second clinical attack and were converted to clinically definite MS. At the start of the study the κ-FLC index was 36.5 and was positive in 76 of 88 patients. The κ-FLC index was significantly associated with white blood cell counts (P <0.001). Compared to patients who did not convert to clinically definite MS, those who did had a significantly increased κ-FLC index during follow-up.

Conversely, the median -FLC index at the start of the study was 12.9 and was positive in 55 of 88 patients. There were no significant relationships between the λ-FLC index and white blood cell counts and the number of T2 hyperintense and contrast enhancing T1 lesions on MRI. However, the λ-FLC index was higher in patients who were positive for OCBs than in patients who were negative (P = 0.001).

Patients with an FLC index greater than 100 at baseline were twice as likely to have a second seizure within 12 months than patients with a lower κ-FLC index.

The likelihood of a second seizure increased by 4 in patients with a high κ-FLC index within 24 months compared to patients with a low index. The median time to have a second attack in patients with high κ-FLC index was 11 months compared to 36 months in patients with low κ-FLC index.

“Current evidence suggests that the κ-FLC index is a reliable prognostic biomarker that could replace OCB measurement, bringing us one step closer to tailored medicine for MS,” the study authors concluded. They added that “more studies in a multicenter setting with higher numbers of patients are needed to replicate the independent prognostic value of the κ-FLC index in early MS. In addition to clinical endpoints such as time to second clinical attack, it may also be of interest to investigate how the κ-FLC index performs in predicting MRI activity in the early course of MS. “

Disclosure: Several authors stated links to the pharmaceutical industry. For a full list of the details, see the original article.

reference

K. Berek, G. Bsteh, M. Auer et al. Kappa-free light chains in CSF prevent the early activity of multiple sclerosis. Neurol Neuroimmunol Neuroinflamm. 2021; 8 (4): e1005. doi: 10.1212 / NXI.0000000000001005

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