Neurology

Elevated baseline sNfL predicts clinical relapse, MRI activity, and progression in MS

Meta-analysis of 13 studies (n=12,513) found elevated baseline serum neurofilament light associated with higher relapse risk (RR 1.42, 95% CI 1.30–1.54). Elevated sNfL also predicted ≥1 gadolinium-enhancing lesion (RR 1.47) and new T2 lesions (RR 2.11). Association with confirmed disease worsening was similar (RR 2.10) though heterogeneity was moderate. These results support using baseline sNfL for prognostic stratification and clinical trial enrichment. 1

Spinal cord stimulation reduces opioid dose and likelihood of ongoing opioid therapy at 12 months

Systematic review and meta-analysis of 43 studies (~1,666 individuals) showed a mean opioid dose reduction of -18.06 MME at 12 months (95% CI -24.41 to -11.70). Odds of continuing opioids at 12 months were lower after implantation (OR 0.47). The pooled evidence is rated as very low certainty by GRADE and largely observational. Await well-powered RCTs before assuming durable opioid-sparing effects for individual patients. 2

Run-in phases or single-arm designs can markedly reduce sample size for geographic atrophy trials

In silico power analyses using GA natural-history data showed run-in phases reduced required sample sizes versus conventional 1:1 RCTs. For 2-year trials with 90% power, sample sizes fell from 156 (standard RCT) to 82, 40, and 26 with 3-, 6-, and 9-month run-ins respectively. Single-arm designs with a run-in required even fewer participants (example: single-arm 14 vs RCT 26 for specified durations). These design choices exploit stable eye-level GA enlargement but require careful bias control before widespread adoption. 3