Prognostic value of kappa free light chain index in patients with primary progressive multiple sclerosis
Year: 2025
Type: article
Study design: Observational Study
Abstract: Background: The kappa free light chain (κ-FLC) index is a well-established biomarker in multiple sclerosis (MS). While the prognostic value of the κ-FLC index has been demonstrated in early relapsing-remitting MS, its prognostic value in primary progressive MS (PPMS) has not yet been investigated. Methods: In this multicenter, retrospective cohort study, patients diagnosed with PPMS with diagnostic lumbar puncture and clinical follow-up of at least 12 months were recruited from nine MS centers across five countries. At baseline, age, sex, disease duration, and the number of T2 hyperintense (T2L) and contrast-enhancing T1 lesions (CEL) on MRI were determined. κ-FLC was measured using nephelometry/turbidimetry, and the κ-FLC index was calculated as (CSF κ-FLC/serum κ-FLC)/albumin quotient. At follow-up, the occurrence of disability progression and the administration of disease-modifying treatment (DMT) were registered. The primary endpoint was time to disability progression. Results: A total of 121 PPMS patients were included with a median age of 53 years (25th-75th percentile: 46-59) and a balanced sex distribution (48.8% female). Multivariable Cox regression analysis revealed no significant association between the κ-FLC index and disability progression [hazard ratio (HR) 1.0, p = 0.950]. Prior use of DMT (HR 0.60, p = 0.023) and brain T2L > 9 at baseline (HR 2.22, p = 0.026) were significantly associated with disability progression. The remaining covariates, including age, sex, disease duration, and CEL, showed no significant associations. Conclusion: The κ-FLC index does not predict disability progression in PPMS, contrasting its growing role as a prognostic biomarker in relapsing MS. This highlights phenotypic differences in MS pathophysiology and underscores the need for prognostic biomarkers in PPMS.
Source: Frontiers in Immunology
Authors: Martin Schmidauer, Klaus Berek, Michael Auer, Gabriel Bsteh, Paola Cavalla, Franziska Di Pauli, Massimiliano Di Filippo, Florian Deisenhammer, Andreja Emeršič, Fabian Föttinger, Lorenzo Gaetani, Michaela Hassler, Nik Krajnc, Dejan Milosavljevic, Markus Ponleitner, Thor Petersen, Stefan Presslauer, Igal Rosenstein, Uroš Rot, Caroline Winther Tørring, Domizia Vecchio, Marco Vercellino, Tobias Zrzavy, Anne Zinganell, Janette Walde, Harald Hegen
Institutions: Innsbruck Medical University, Universität Innsbruck, Medical University of Vienna, Azienda Ospedaliera Citta' della Salute e della Scienza di Torino, University of Perugia, University of Ljubljana, Ljubljana University Medical Centre, Hochschule Campus Wien, Sygehus Sønderjylland, University of Gothenburg, Aarhus University Hospital, Azienda Ospedaliero Universitaria Maggiore della Carita
Language: English
Subfield: Clinical Neurology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,801
Funders: Amgen, Bristol-Myers Squibb, Eli Lilly and Company, Sanofi, Biogen, Teva Pharmaceutical Industries, Alexion Pharmaceuticals, Celgene, European Committee for Treatment and Research in Multiple Sclerosis, Amicus Therapeutics, Mylan, Horizon Therapeutics, Eisai, Siemens Healthineers, European Academy of Neurology, Neuraxpharm
OpenAlex ID: W4415982017