CSF ß-amyloid predicts prognosis in patients with multiple sclerosis

Background: The importance of predicting disease progression in multiple sclerosis (MS) has increasingly been recognised, hence reliable biomarkers are needed. Objectives: To investigate the prognostic role of cerebrospinal fluid (CSF) Amyloid beta1-42 (A?) levels by the determination of a cut-off value to classify patients in slow and fast progressors. To evaluate possible association with white (WM) and grey matter (GM) damage at early disease stages. Methods: Sixty patients were recruited and followed-up for three to five years. Patients underwent clinical assessment, CSF analysis to determine Aß levels, and brain MRI (at baseline and after 1 year). T1-weighted volumes were calculated. T2-weighted scans were used to quantify WM lesion loads. Results: Lower CSF Aß levels were observed in patients with a worse follow-up EDSS (r=-0.65, p<0.001). The multiple regression analysis confirmed CSF Aß concentration as a predictor of patients’ EDSS increase (r=-0.59, p<0.0001). Generating a receiver operator characteristic curve, a cut-off value of 813 pg/ml was determined as the threshold able to identify patients with worse prognosis (95%CI 0.690-0.933, p=0.0001). No differences in CSF tau and NfL levels were observed (p>0.05). Conclusions: Low CSF Aß levels may represent a predictive biomarker of disease progression in MS.