Evidence map›Paper›PMID 40296363›Full record

ArticleMultiple sclerosis (Houndmills, Basingstoke, England)2025

Personalized treatment decision algorithms for the clinical application of serum neurofilament light chain in multiple sclerosis: A modified Delphi Study.

Özgür Yaldizli, Pascal Benkert, Lutz Achtnichts, Amit Bar-Or, Viviane Bohner-Lang, Claire Bridel, Manuel Comabella, Oliver Findling, Giulio Disanto, Sebastian Finkener and 33 more

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Article in Multiple sclerosis (Houndmills, Basingstoke, England), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed.

  1. Trial
  2. Article
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  5. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

43 authors.

Özgür YaldizliDepartment of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland.
Pascal BenkertDepartment of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland.ORCID 0000-0001-6525-8174
Lutz AchtnichtsNeurozentrum Oberaargau, Langenthal, Switzerland.
Amit Bar-OrCenter for Neuroinflammation and Experimental Therapeutics and Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.ORCID 0000-0001-7179-0335
Viviane Bohner-LangPatient Consultant, Basel, Switzerland.
Claire BridelTranslational Biomarker Research Group, Department of Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland.ORCID 0000-0001-7267-7676
Manuel ComabellaMultiple Sclerosis Centre of Catalonia (Cemcat), Vall d'Hebron Barcelona Hospital, Barcelona, Spain.ORCID 0000-0002-2373-6657
Oliver FindlingDepartment of Neurology, Cantonal Hospital Aarau, Aarau, Switzerland.
Giulio DisantoMultiple Sclerosis Center, Neurocenter of Southern Switzerland, Ospedale Regionale di Lugano (EOC), Lugano, Switzerland.ORCID 0000-0002-8512-6096
Sebastian FinkenerDepartment of Neurology, Cantonal Hospital Aarau, Aarau, Switzerland.
Claudio GobbiMultiple Sclerosis Center, Neurocenter of Southern Switzerland, Ospedale Regionale di Lugano (EOC), Lugano, Switzerland.ORCID 0000-0002-7554-0664
Cristina GranzieraResearch Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel, University of Basel, Basel, Switzerland.ORCID 0000-0002-4917-8761
Marina HerwerthDepartment of Neurology, University Hospital Zurich, Zurich, Switzerland.
Robert HoepnerDepartment of Neurology, Bern University Hospital, University of Bern, Bern, Switzerland.
Dana HorakovaDepartment of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic.ORCID 0000-0003-1915-0036
Nicole KamberDivision of Neurology, Department of Internal Medicine, Bürgerspital Solothurn, Solothurn, Switzerland.
Michael KhalilDepartment of Neurology, Medical University of Graz, Graz, Austria.ORCID 0000-0002-5350-3328
Philipp KunzPatient Consultant, Basel, Switzerland.
Patrice LaliveDivision of Neurology, Department of Clinical Neurosciences, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland.
Ralf LinkerDepartment of Neurology, University of Regensburg, Regensburg, Germany.
Johannes LorscheiderResearch Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel, University of Basel, Basel, Switzerland.
Stefanie MüllerDepartment of Neurology, University Teaching and Research Hospital St. Gallen, St. Gallen, Switzerland.
Johanna OechteringResearch Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel, University of Basel, Basel, Switzerland.
Victoria PettypoolPatient Consultant, Basel, Switzerland.
Fredrik PiehlDepartment of Neurology, Karolinska University Hospital, Stockholm, Sweden.ORCID 0000-0001-8329-5219
Caroline PotService of Neurology, Department of Clinical Neurosciences, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland.ORCID 0000-0002-1146-3129
Patrick RothDepartment of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
Marie ThéaudinService of Neurology, Department of Clinical Neurosciences, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland.
Mar TintoreMultiple Sclerosis Centre of Catalonia (Cemcat), Vall d'Hebron Barcelona Hospital, Barcelona, Spain.ORCID 0000-0001-9999-5359
Carmen TurMultiple Sclerosis Centre of Catalonia (Cemcat), Vall d'Hebron Barcelona Hospital, Barcelona, Spain.ORCID 0000-0003-1849-3184
Denis UfferDepartment of Neurology, University Teaching and Research Hospital St. Gallen, St. Gallen, Switzerland.
Marjolaine UginetDivision of Neurology, Department of Clinical Neurosciences, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland.
Jochen VehoffDepartment of Neurology, University Teaching and Research Hospital St. Gallen, St. Gallen, Switzerland.
Heinz WiendlDepartment of Neurology, Institute of Translational Neurology, University Hospital Münster, Münster, Germany.ORCID 0000-0003-4310-3432
Tjalf ZiemssenCenter of Clinical Neuroscience, Neurological Clinic, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany.
Chiara ZeccaMultiple Sclerosis Center, Neurocenter of Southern Switzerland, Ospedale Regionale di Lugano (EOC), Lugano, Switzerland.ORCID 0000-0002-9990-3431
Anke SalmenDepartment of Neurology, Ruhr-University Bochum, St. Josef-Hospital, Bochum, Germany.
David LeppertResearch Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel, University of Basel, Basel, Switzerland.
Tobias DerfussResearch Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel, University of Basel, Basel, Switzerland.ORCID 0000-0001-8431-8769
Ludwig KapposResearch Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel, University of Basel, Basel, Switzerland.ORCID 0000-0003-4175-5509
Lars G HemkensDepartment of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland.
Perrine JaniaudResearch Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel, University of Basel, Basel, Switzerland.ORCID 0000-0001-7684-8014
Jens KuhleResearch Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel, University of Basel, Basel, Switzerland.ORCID 0000-0002-6963-8892

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundSerum 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.

objectiveWe here propose treatment decision algorithms incorporating sNfL levels to adapt disease-modifying therapies (DMTs).

methodsWe 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%).

resultsThe 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).

conclusionThe 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.

Indexed as

AlgorithmsClinical Decision-MakingImmunologic FactorsMultiple SclerosisNeurofilament ProteinsPrecision MedicineAdultConsensusDelphi TechniqueFemaleHumansMaleMiddle AgedImmunologic Factorsneurofilament protein LNeurofilament Proteinsde-escalationDelphi studyescalationpersonalized treatment strategiesserum neurofilament light chain

Identifiers

PMID40296363
PMCPMC12228887

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