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2. Recovery of dialysis patients with COVID-19: health outcomes 3 months after diagnosis in ERACODA

Author

Hemmelder, M. H., Noordzij, M., Vart, P., Hilbrands, L. B., Jager, K. J., Abrahams, A. C., Arroyo, D., Battaglia, Y., Ekart, R., Mallamaci, F., Malloney, S. -R., Oliveira, J., Rydzewski, A., Sridharan, S., Vogt, L., Duivenvoorden, R., Gansevoort, R. T., Franssen, C. F. M., van der Net, J. B., Essig, M., du Buf-Vereijken, P. W. G., van Ginneken, B., Maas, N., van Jaarsveld, B. C., Bemelman, F. J., Klingenberg-Salahova, F., Heenan-Vos, F., Vervloet, M. G., Nurmohamed, A., Abramowicz, D., Verhofstede, S., Maoujoud, O., Malfait, T., Fialova, J., Melilli, E., Fava, A., Cruzado, J. M., Perez, N. M., Lips, J., Krepel, H., Adilovic, H., Hengst, M., Konings, C. J. A. M., Braconnier, P., Weis, D., Gellert, R., Alferes, D. G., Radulescu, D., Zakharova, E. V., Ambuehl, P. M., Guidotti, R., Walker, A., Lepeytre, F., Rabate, C., Rostoker, G., Marques, S., Azasevac, T., Majstorovic, G. S., Katicic, D., Dam, M. T., Kruger, T., Brzosko, S., Liakopoulos, V., Zanen, A. L., Logtenberg, S. J. J., Fricke, L., Kuryata, O., Slebe, J. J. P., Abd ElHafeez, S., Kemlin, D., van de Wetering, J., Reinders, M. E. J., Hesselink, D. A., van Gestel, J. K., Eiselt, J., Kielberger, L., El-Wakil, H. S., Verhoeven, M. A. M., Logan, I., Canal, C., Facundo, C., Ramos, A. M., Debska-Slizien, A., Veldhuizen, N. M. H., Tigka, E., Polyzou Konsta, M. A., Panagoutsos, S., Postorino, A., Cambareri, F., Matceac, I., Nistor, I., Covic, A., Groeneveld, J. H. M., Jousma, J., Diekmann, F., Oppenheimer, F., Blasco, M., Pereira, T. A., dos Santos Junior, A. C. S., Arias-Cabrales, C., Crespo, M., Llinas-Mallol, L., Buxeda, A., Tarrega, C. B., Redondo-Pachon, D., Arenas Jimenez, M. D., Mendoza-Valderrey, A., Martins, A. C., Mateus, C., Alvila, G., Laranjinha, I., Hofstra, J. M., Siezenga, M. A., Franco, A., Castellano, S., Rodriguez-Ferrero, M. L., Manzanos, S. B., Haridian Sosa Barrios, R., Lemahieu, W., Bartelet, K., Dirim, A. B., Demir, E., Sever, M. S., Turkmen, A., Safak, S., Hollander, D. A. M. J., Kerckhoffs, A., Buttner, S., de Vries, A. P. J., Meziyerh, S., van der Helm, D., Mallat, M., Bouwsma, H., Petruliene, K., Verberk, I., van der Sande, F. M., Christiaans, M. H. L., Mohankumar, N., Luca, M. D., Tuglular, S. Z., Kramer, A., Beerenhout, C., Luik, P. T., Kerschbaum, J., Tiefenthaler, M., Watschinger, B., Adema, A. Y., Stepanov, V. A., Zulkarnaev, A. B., Turkmen, K., Gandolfini, I., Maggiore, U., Fliedner, A., Asberg, A., Mjoen, G., Miyasato, H., de Fijter, C. W. H., Mongera, N., Pini, S., de Biase, C., van de Logt, A. E., Maas, R., Lebedeva, O., Lopez, V., Reichert, L. J. M., Verhave, J., Titov, D., Parshina, E. V., Zanoli, L., Marcantoni, C., van Kempen, G., van Gils-Verrij, L. E. A., Harty, J. C., Meurs, M., Myslak, M., Lentini, P., den Deurwaarder, E., Stendahl, M., Rahimzadeh, H., Schouten, M., Rychlik, I., Cabezas-Reina, C. J., Roca, A. M., Nauta, F., Sahin, I., Goffin, E., Kanaan, N., Labriola, L., Devresse, A., Diaz-Mareque, A., Coca, A., de Arriba, G., Meijers, B. K. I., Naesens, M., Kuypers, D., Desschans, B., Tonnerlier, A., Wissing, K. M., Dedinska, I., Pessolano, G., Malik, S., Dounousi, E., Papachristou, E., Berger, S. P., Meijer, E., Sanders, J. S. F., Ozyilmaz, A., Ponikvar, J. B., Pernat, A. M., Kovac, D., Arnol, M., Molenaar, F. M., van Zuilen, A. D., Meijvis, S. C. A., Dolmans, H., Tantisattamo, E., Esposito, P., Krzesinski, J. -M., Barahira, J. D., Gallieni, M., Martin-Moreno, P. L., Guglielmetti, G., Guzzo, G., Toapanta, N., Soler, M. J., Luik, A. J., van Kuijk, W. H. M., Stikkelbroeck, L. W. H., Hermans, M. M. H., Rimsevicius, L., Righetti, M., Islam, M., Heitink-Ter Braak, N., Nephrology, ACS - Microcirculation, ACS - Diabetes & metabolism, UCL - SSS/IREC/NEFR - Pôle de Néphrologie, UCL - (SLuc) Service de néphrologie, Clinical sciences, Faculteit Medische Wetenschappen/UMCG, Groningen Kidney Center (GKC), Cardiovascular Centre (CVC), Groningen Institute for Organ Transplantation (GIOT), Interne Geneeskunde, RS: Carim - V02 Hypertension and target organ damage, Medical Informatics, APH - Aging & Later Life, APH - Quality of Care, APH - Global Health, ACS - Pulmonary hypertension & thrombosis, APH - Health Behaviors & Chronic Diseases, and Internal Medicine

Subjects
Male, Outcome Assessment, survival, mental health status, COVID-19 Testing, SDG 3 - Good Health and Well-being, Renal Dialysis, functional health status, Outcome Assessment, Health Care, 80 and over, Humans, KIDNEY-TRANSPLANT, AcademicSubjects/MED00340, Aged, Aged, 80 and over, Transplantation, SARS-CoV-2, MORTALITY, COVID-19, Middle Aged, Health Care, Intensive Care Units, Renal disorders Radboud Institute for Molecular Life Sciences [Radboudumc 11], Nephrology, dialysis, Original Article, Female, Renal disorders Radboud Institute for Health Sciences [Radboudumc 11]
Abstract

Background Coronavirus disease 2019 (COVID-19)-related short-term mortality is high in dialysis patients, but longer-term outcomes are largely unknown. We therefore assessed patient recovery in a large cohort of dialysis patients 3 months after their COVID-19 diagnosis. Methods We analyzed data on dialysis patients diagnosed with COVID-19 from 1 February 2020 to 31 March 2021 from the European Renal Association COVID-19 Database (ERACODA). The outcomes studied were patient survival, residence and functional and mental health status (estimated by their treating physician) 3 months after COVID-19 diagnosis. Complete follow-up data were available for 854 surviving patients. Patient characteristics associated with recovery were analyzed using logistic regression. Results In 2449 hemodialysis patients (mean ± SD age 67.5 ± 14.4 years, 62% male), survival probabilities at 3 months after COVID-19 diagnosis were 90% for nonhospitalized patients (n = 1087), 73% for patients admitted to the hospital but not to an intensive care unit (ICU) (n = 1165) and 40% for those admitted to an ICU (n = 197). Patient survival hardly decreased between 28 days and 3 months after COVID-19 diagnosis. At 3 months, 87% functioned at their pre-existent functional and 94% at their pre-existent mental level. Only few of the surviving patients were still admitted to the hospital (0.8–6.3%) or a nursing home (∼5%). A higher age and frailty score at presentation and ICU admission were associated with worse functional outcome. Conclusions Mortality between 28 days and 3 months after COVID-19 diagnosis was low and the majority of patients who survived COVID-19 recovered to their pre-existent functional and mental health level at 3 months after diagnosis.

Published
2022

3. Clinical triage of patients on kidney replacement therapy presenting with COVID-19: An ERACODA registry analysis

Author

Mitra, S., Jayanti, A., Vart, P., Coca, A., Gallieni, M., Ovrehus, M. A., Midtvedt, K., Abd Elhafeez, S., Gandolfini, I., Buttner, S., Franssen, C. F. M., Hemmelder, M. H., Van Der Net, J. B., Essig, M., Du Buf-Vereijken, P. W. G., Van Ginneken, B., Maas, N., Vogt, L., Van Jaarsveld, B. C., Jager, K. J., Bemelman, F. J., Klingenberg-Salahova, F., Heenan-Vos, F., Vervloet, M. G., Nurmohamed, A., Abramowicz, D., Verhofstede, S., Maoujoud, O., Malfait, T., Fialova, J., Melilli, E., Fava, A., Cruzado, J. M., Perez, N. M., Lips, J., Krepel, H., Adilovic, H., Hengst, M., Rydzewski, A., Gellert, R., Oliveira, J., Alferes, D. G., Zakharova, E. V., Ambuehl, P. M., Walker, A., Winzeler, R., Lepeytre, F., Rabate, C., Rostoker, G., Marques, S., Azasevac, T., Katicic, D., Dam, M. T., Kruger, T., Brzosko, S., Zanen, A. L., Logtenberg, S. J. J., Fricke, L., Slebe, J. J. P., Kemlin, D., Van De Wetering, J., Reinders, M. E. J., Eiselt, J., Kielberger, L., El-Wakil, H. S., Verhoeven, M. A. M., Canal, C., Facundo, C., Ramos, A. M., Debska-Slizien, A., Veldhuizen, N. M. H., Tigka, E., Konsta, M. A. P., Panagoutsos, S., Mallamaci, F., Postorino, A., Cambareri, F., Covic, A., Matceac, I., Nistor, I., Cordos, M., Groeneveld, J. H. M., Jousma, J., Marjolijn Van Buren, Diekmann, F., Tiago Assis Pereira, Santos, A. C. S., Arias-Cabrales, C., Crespo, M., Llinas-Mallol, L., Buxeda, A., Tarrega, C. B., Redondo-Pachon, D., Jimenez, M. D. A., Hofstra, J. M., Franco, A., Arroyo, D., Rodriguez-Ferrero, M. L., Manzanos, S. B., Barrios, R. H. S., Avila, G., Laranjinha, I., Mateus, C., Lemahieu, W., Bartelet, K., Dirim, A. B., Sever, M. S., Demir, E., Safak, S., Turkmen, A., Hollander, D. A. M. J., De Vries, A. P. J., Meziyerh, S., Van Der Helm, D., Mallat, M., Bouwsma, H., Sridharan, S., Petruliene, K., Maloney, S. -R., Verberk, I., Van Der Sande, F. M., Christiaans, M. H. L., Mohankumar, N., Di Luca, M., Tuglular, S. Z., Kramer, A., Beerenhout, C., Luik, P. T., Kerschbaum, J., Tiefenthaler, M., Watschinger, B., Adema, A. Y., Stepanov, V. A., Zulkarnaev, A. B., Turkmen, K., Fliedner, A., Asberg, A., Mjoen, G., Miyasato, H., De Fijter, C. W. H., Mongera, N., Pini, S., De Biase, C., Duivenvoorden, R., Hilbrands, L., Kerckhoffs, A., Van De Logt, A. -E., Maas, R., Lebedeva, O., Lopez, V., Verhave, J., Reichert, L. J. M., Titov, D., Parshina, E. V., Zanoli, L., Marcantoni, C., Van Gils-Verrij, L. E. A., Harty, J. C., Meurs, M., Myslak, M., Battaglia, Y., Lentini, P., Den Deurwaarder, E., Stendahl, M., Rahimzadeh, H., Schouten, M., Rychlik, I., Cabezas-Reina, C. J., Roca, A. M., Nauta, F., Goffin, E., Kanaan, N., Labriola, L., Devresse, A., Diaz-Mareque, A., Meijers, B. K. I., Naesens, M., Kuypers, D., Desschans, B., Tonnelier, A., Wissing, K. M., De Arriba, G., Dedinska, I., Pessolano, G., Maggiore, U., Malik, S., Papachristou, E., Gansevoort, R. T., Noordzij, M., Berger, S. P., Meijer, E., Ozyilmaz, A., Sanders, J. S. F., Ponikvar, J. B., Arnol, M., Pernat, A. M., Kovac, D., Ekart, R., Abrahams, A. C., Molenaar, F. M., Van Zuilen, A. D., Meijvis, S. C. A., Dolmans, H., Tantisattamo, E., Esposito, P., Krzesinski, J. -M., Barahira, J. D., Sabiu, G., Martin-Moreno, P. L., Guglielmetti, G., Guzzo, G., Toapanta, N., Soler, M. J., Luik, A. J., Van Kuijk, W. H. M., Stikkelbroeck, L. W. H., Hermans, M. M. H., Rimsevicius, L., Righetti, M., Islam, M., Braak, N. H. -T., Nephrology, UCL - SSS/IREC/NEFR - Pôle de Néphrologie, UCL - (SLuc) Service de néphrologie, Interne Geneeskunde, RS: Carim - V02 Hypertension and target organ damage, Groningen Kidney Center (GKC), ACS - Diabetes & metabolism, AII - Inflammatory diseases, AII - Infectious diseases, Internal Medicine, and Clinical sciences

Subjects
kidney, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), medicine.medical_treatment, Pulmonary insufficiency, infectious diseases, Kidney, Second presentation, Interquartile range, Internal medicine, medicine, Humans, Registries, Mortality, AcademicSubjects/MED00340, Dialysis, Aged, Transplantation, second presentation, business.industry, SARS-CoV-2, COVID-19, medicine.disease, mortality, Triage, Hospitalization, Renal Replacement Therapy, Renal disorders Radboud Institute for Molecular Life Sciences [Radboudumc 11], Nephrology, Oxygen Saturation, dialysis, Original Article, Hemodialysis, Renal disorders Radboud Institute for Health Sciences [Radboudumc 11], Presentation (obstetrics), business, transplantation
Abstract

Background Patients on kidney replacement therapy (KRT) are at very high risk of coronavirus disease 2019 (COVID-19). The triage pathway for KRT patients presenting to hospitals with varying severity of COVID-19 illness remains ill-defined. We studied the clinical characteristics of patients at initial and subsequent hospital presentations and the impact on patient outcomes. Methods The European Renal Association COVID-19 Database (ERACODA) was analysed for clinical and laboratory features of 1423 KRT patients with COVID-19 either hospitalized or non-hospitalized at initial triage and those re-presenting a second time. Predictors of outcomes (hospitalization, 28-day mortality) were then determined for all those not hospitalized at initial triage. Results Among 1423 KRT patients with COVID-19 [haemodialysis (HD), n = 1017; transplant, n = 406), 25% (n = 355) were not hospitalized at first presentation due to mild illness (30% HD, 13% transplant). Of the non-hospitalized patients, only 10% (n = 36) re-presented a second time, with a 5-day median interval between the two presentations (interquartile range 2–7 days). Patients who re-presented had worsening respiratory symptoms, a decrease in oxygen saturation (97% versus 90%) and an increase in C-reactive protein (26 versus 73 mg/L) and were older (72 vs 63 years) compared with those who did not return a second time. The 28-day mortality between early admission (at first presentation) and deferred admission (at second presentation) was not significantly different (29% versus 25%; P = 0.6). Older age, prior smoking history, higher clinical frailty score and self-reported shortness of breath at first presentation were identified as risk predictors of mortality when re-presenting after discharge at initial triage. Conclusions This study provides evidence that KRT patients with COVID-19 and mild illness can be managed effectively with supported outpatient care and with vigilance of respiratory symptoms, especially in those with risk factors for poor outcomes. Our findings support a risk-stratified clinical approach to admissions and discharges of KRT patients presenting with COVID-19 to aid clinical triage and optimize resource utilization during the ongoing pandemic.

Published
2021

4. Serum neurofilaments as candidate biomarkers of natalizumab-associated PML

Author

Loonstra, F. C., Verberk, I. M. W., Wijburg, M. T., Wattjes, M. P., Teunissen, C. E., van Oosten, B. W., Uitdehaag, B. M. J., Killestein, J., van Kempen, Z. L. E., Neurology, Clinical chemistry, Other Research, Amsterdam Neuroscience - Neuroinfection & -inflammation, Amsterdam Neuroscience - Neurodegeneration, and AII - Inflammatory diseases

Published
2019

6. Biomarker-based staging of Alzheimer disease: rationale and clinical applications.

Author

Therriault J, Schindler SE, Salvadó G, Pascoal TA, Benedet AL, Ashton NJ, Karikari TK, Apostolova L, Murray ME, Verberk I, Vogel JW, La Joie R, Gauthier S, Teunissen C, Rabinovici GD, Zetterberg H, Bateman RJ, Scheltens P, Blennow K, Sperling R, Hansson O, Jack CR Jr, and Rosa-Neto P

Subjects
Humans, Amyloid beta-Peptides, Positron-Emission Tomography, Biomarkers cerebrospinal fluid, Alzheimer Disease diagnostic imaging
Abstract

Disease staging, whereby the spatial extent and load of brain pathology are used to estimate the severity of Alzheimer disease (AD), is pivotal to the gold-standard neuropathological diagnosis of AD. Current in vivo diagnostic frameworks for AD are based on abnormal concentrations of amyloid-β and tau in the cerebrospinal fluid or on PET scans, and breakthroughs in molecular imaging have opened up the possibility of in vivo staging of AD. Focusing on the key principles of disease staging shared across several areas of medicine, this Review highlights the potential for in vivo staging of AD to transform our understanding of preclinical AD, refine enrolment criteria for trials of disease-modifying therapies and aid clinical decision-making in the era of anti-amyloid therapeutics. We provide a state-of-the-art review of recent biomarker-based AD staging systems and highlight their contributions to the understanding of the natural history of AD. Furthermore, we outline hypothetical frameworks to stage AD severity using more accessible fluid biomarkers. In addition, by applying amyloid PET-based staging to recently published anti-amyloid therapeutic trials, we highlight how biomarker-based disease staging frameworks could illustrate the numerous pathological changes that have already taken place in individuals with mildly symptomatic AD. Finally, we discuss challenges related to the validation and standardization of disease staging and provide a forward-looking perspective on potential clinical applications., (© 2024. Springer Nature Limited.)

Published
2024
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7. Development and multi-center validation of a fully automated digital immunoassay for neurofilament light chain: toward a clinical blood test for neuronal injury.

Author

Wilson D, Chan D, Chang L, Mathis R, Verberk I, Montalban X, Comabella M, Fissolo N, Bielekova B, Masvekar R, Chitnis T, Ziemssen T, Akgün K, Blennow K, Zetterberg H, Brück W, Giovannoni G, Gnanapavan S, Bittner S, Zipp F, Comi G, Furlan R, Lehmann S, Thebault S, Freedman M, Bar-Or A, Kramer M, Otto M, Halbgebauer S, Hrusovsky K, Plavina T, Khalil M, Piehl F, Wiendl H, Kappos L, Maceski A, Willemse E, Leppert D, Teunissen C, and Kuhle J

Subjects
Humans, Reproducibility of Results, Immunoassay, Neurofilament Proteins, Biomarkers, Hematologic Tests, Intermediate Filaments, Neurons
Abstract

Objectives: Neurofilament light chain (NfL) has emerged as a promising biomarker for detecting and monitoring axonal injury. Until recently, NfL could only be reliably measured in cerebrospinal fluid, but digital single molecule array (Simoa) technology has enabled its precise measurement in blood samples where it is typically 50-100 times less abundant. We report development and multi-center validation of a novel fully automated digital immunoassay for NfL in serum for informing axonal injury status., Methods: A 45-min immunoassay for serum NfL was developed for use on an automated digital analyzer based on Simoa technology. The analytical performance (sensitivity, precision, reproducibility, linearity, sample type) was characterized and then cross validated across 17 laboratories in 10 countries. Analytical performance for clinical NfL measurement was examined in individual patients with relapsing remitting multiple sclerosis (RRMS) after 3 months of disease modifying treatment (DMT) with fingolimod., Results: The assay exhibited a lower limit of detection (LLoD) of 0.05 ng/L, a lower limit of quantification (LLoQ) of 0.8 ng/L, and between-laboratory imprecision <10 % across 17 validation sites. All tested samples had measurable NfL concentrations well above the LLoQ. In matched pre-post treatment samples, decreases in NfL were observed in 26/29 RRMS patients three months after DMT start, with significant decreases detected in a majority of patients., Conclusions: The sensitivity characteristics and reproducible performance across laboratories combined with full automation make this assay suitable for clinical use for NfL assessment, monitoring in individual patients, and cross-comparisons of results across multiple sites., (© 2023 Walter de Gruyter GmbH, Berlin/Boston.)

Published
2023
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8. [Home telemonitoring and oxygen therapy in COVID-19 patients: safety, patient satisfaction, and cost-effectiveness].

Author

van Herwerden MC, van Steenkiste J, El Moussaoui R, den Hollander JG, Helfrich G, and J A M Verberk I

Subjects
Cost-Benefit Analysis, Eligibility Determination, Female, Humans, Male, Middle Aged, Netherlands epidemiology, Patient Discharge, Patient Safety, Patient Satisfaction, Retrospective Studies, SARS-CoV-2 isolation & purification, COVID-19 diagnosis, COVID-19 epidemiology, COVID-19 rehabilitation, COVID-19 therapy, Home Care Services, Hospital-Based organization & administration, Length of Stay economics, Length of Stay statistics & numerical data, Monitoring, Physiologic methods, Oxygen Inhalation Therapy methods, Telemedicine economics, Telemedicine methods
Abstract

Objective: To evaluate the implementation of home telemonitoring and oxygen therapy in COVID-19 patients. Primary outcomes were safety, patient satisfaction, reduction of hospital stay, and cost-effectiveness., Design: Retrospective cohort study., Method: All COVID-19 patients who were discharged with home telemonitoring and oxygen therapy between June 1st and November 1st 2020 were included. Eligible patients had a maximum oxygen requirement of 2 liters per minute during the 24 hours prior to discharge with a minimal peripheral oxygen saturation of 94%. A mobile application for telemonitoring was used, which patients or relatives had to be able to use independently. Patient demographics, clinical parameters, data on telemonitoring and readmissions were extracted from the electronic patient records. A survey for patient satisfaction and a cost-effectiveness analysis were performed., Results: Out of 619 admissions, 49 patients were discharged with home telemonitoring and oxygen therapy. Median duration of home oxygen therapy was 11 days with a potential reduction in hospitalization of 616 days. Six patients were readmitted and were significantly more febrile on discharge (67% versus 14%, p=0.01) and had lower oxygenation (95%, (IQR 93-96) versus 96%, (IQR 95-97), p=0.02) with similar levels of oxygen administration. Patient satisfaction was high with a mean score of 5 to 6 on a scale measuring satisfaction from 1 to 7. Estimated total cost reduction was € 146.736., Conclusion: This study shows that home telemonitoring and oxygen administration can be safely applied in COVID-19 patients resulting in a high patient satisfaction and reduction in hospital stay and costs.

Published
2021

9. Variations in consecutive serum neurofilament light levels in healthy controls and multiple sclerosis patients.

Author

Bridel C, Verberk IMW, Heijst JJA, Killestein J, and Teunissen CE

Subjects
Biomarkers, Humans, Intermediate Filaments, Neurofilament Proteins, Multiple Sclerosis, Multiple Sclerosis, Relapsing-Remitting diagnostic imaging
Abstract

Background Neurofilament light is a neuronal protein detectable in serum (sNfL), with high potential as disease activity biomarker in multiple sclerosis (MS). To date, little is known about sNfL fluctuations between 2 consecutive measurements in healthy controls (HC) and MS patients. Yet this information is critical, as it will help define a clinically significant variation. Methods sNfL was measured at 2 consecutive time points in a cohort of 90 MS patients (untreated relapsing remitting MS (uRRMS), n=35; treated relapsing remitting MS (tRRMS), n= 21; secondary progressive MS, SPMS, n=21; primary progressive MS, PPMS, n=13), and 90 age-matched HC, using the Simoa NfL light® assay. Results Mean sNfL was elevated in all MS subtypes compared to HC (p<0.0001), and positively associated with age in HC (r=0.70, p<0.001), confirming previous reports. Mean sNfL was higher at follow-up compared to baseline in HC (p<0.001), and lower in uRRMS(p=0.036) and tRRMS (p=0.008). At follow-up, a similar proportion of HC (50.0%), untreated RRMS (51.4%), treated RRMS (33.3%), SPMS (45.0%) and PPMS (46.2%) had variations in sNfL levels exceeding 20% of baseline levels. Conclusions Our data suggest variations in sNfL occur both in HC and MS populations to a similar extent and magnitude. Variations between two consecutive sNfL measurements may reflect natural variations and not necessarily variations in inflammatory disease activity., (Copyright © 2020 The Authors. Published by Elsevier B.V. All rights reserved.)

Published
2021
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