Serum GFAP and Age Accurately Distinguish AQP4 ‐ IgG Positive and Double Seronegative NMOSD From MOGAD After a Recent Attack
Abstract
Background: Serum neurofilament-light chain (sNfL) and glial fibrillary acidic protein (sGFAP) are associated with multiple sclerosis (MS) activity. This study aimed to identify patient- and disease-level determinants of sNfL and sGFAP and to evaluate their ability to support differential diagnosis in neuromyelitis optica (NMO). Methods: sNFL and sGFAP levels were measured in 640 patients from the OFSEP cohort (88 NMO spectrum disorder (NMOSD) with anti-aquaporin-4 antibodies [AQP4-NMOSD], 28 double-seronegative NMOSD [DN-NMOSD], 61 myelin oligodendrocyte glycoprotein antibody-associated disease [MOGAD], 64 clinically isolated syndrome [CIS], 237 relapsing-remitting MS [RRMS], and 162 primary progressive MS [PPMS]). The association between log[sNFL] and log[sGFAP] and age, sex, time since relapse, EDSS, oligoclonal bands, and MRI characteristics was analyzed by multiple linear regression. The diagnostic performance of sNfL and sGFAP in discriminating between NMOSD and MS subgroups was evaluated using multivariable logistic regression and area under the curve (AUC). Results: For each group, specific associations of sNFL and sGFAP levels with patient characteristics were observed. Clearest associations were observed in AQP4-NMOSD patients. After a recent attack (≤ 90 days), multivariate analysis revealed that sGFAP and age discriminated AQP4-NMOSD from MOGAD (AUC = 0.939 [0.910;0.982]), AQP4-NMOSD and DN-NMOSD from MOGAD (AUC = 0.863 [0.776;0.977]), and AQP4-NMOSD from all other groups (AUC = 0.950 [0.918;0.987]). Diagnostic probability heatmaps based on sGFAP and age illustrate the probability of each diagnosis relative to others for bedside interpretation. Conclusion: After an acute attack of NMOSD, risk score based on sGFAP and age may guide the management of patients before autoantibody status is available.
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BibTeX
@article{rival2026serum,
title = {{Serum GFAP and Age Accurately Distinguish AQP4 ‐ IgG Positive and Double Seronegative NMOSD From MOGAD After a Recent Attack}},
author = {Manon Rival and Fabien Rollot and Sabine Laurent‐chabalier and Romain Casey and Illiasse El Bahi and Guillaume Brocard and Romain Marignier and Sophie Trouillet‐assant and Sandra Vukusic and Agnès Fromont and David Axel Laplaud and Guillaume Mathey and Elisabeth Maillart and Laure Michel and Aurélie Ruet and Pierre Labauge and Xavier Ayrignac and Hélène Zephir and Jonathan Ciron and Jérôme de Sèze and Arnaud Kwiatkowski and Caroline Papeix and Pierre Branger and Christine Lebrun‐frenay and Eric Berger and Pierre Clavelou and Olivier Heinzlef and Jean Pelletier and Abdullatif Al‐khedr and Olivier Casez and Bertrand Bourre and Alain Créange and Thomas David and Laurent Magy and Jean‐philippe Camdessanche and Inès Doghri and Amélie dos Santos and Thibault Mura and Hanane Agherbi and Eric Thouvenot},
journal = {European Journal of Neurology},
year = {2026},
month = oct,
doi = {10.1111/ene.70767},
url = {https://hal.science/hal-05781754v1},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Serum GFAP and Age Accurately Distinguish AQP4 ‐ IgG Positive and Double Seronegative NMOSD From MOGAD After a Recent Attack
AU - Manon Rival
AU - Fabien Rollot
AU - Sabine Laurent‐chabalier
AU - Romain Casey
AU - Illiasse El Bahi
AU - Guillaume Brocard
AU - Romain Marignier
AU - Sophie Trouillet‐assant
AU - Sandra Vukusic
AU - Agnès Fromont
AU - David Axel Laplaud
AU - Guillaume Mathey
AU - Elisabeth Maillart
AU - Laure Michel
AU - Aurélie Ruet
AU - Pierre Labauge
AU - Xavier Ayrignac
AU - Hélène Zephir
AU - Jonathan Ciron
AU - Jérôme de Sèze
AU - Arnaud Kwiatkowski
AU - Caroline Papeix
AU - Pierre Branger
AU - Christine Lebrun‐frenay
AU - Eric Berger
AU - Pierre Clavelou
AU - Olivier Heinzlef
AU - Jean Pelletier
AU - Abdullatif Al‐khedr
AU - Olivier Casez
AU - Bertrand Bourre
AU - Alain Créange
AU - Thomas David
AU - Laurent Magy
AU - Jean‐philippe Camdessanche
AU - Inès Doghri
AU - Amélie dos Santos
AU - Thibault Mura
AU - Hanane Agherbi
AU - Eric Thouvenot
PY - 2026
DA - 2026/10/06
JO - European Journal of Neurology
DO - 10.1111/ene.70767
UR - https://hal.science/hal-05781754v1
AB - Background: Serum neurofilament-light chain (sNfL) and glial fibrillary acidic protein (sGFAP) are associated with multiple sclerosis (MS) activity. This study aimed to identify patient- and disease-level determinants of sNfL and sGFAP and to evaluate their ability to support differential diagnosis in neuromyelitis optica (NMO). Methods: sNFL and sGFAP levels were measured in 640 patients from the OFSEP cohort (88 NMO spectrum disorder (NMOSD) with anti-aquaporin-4 antibodies [AQP4-NMOSD], 28 double-seronegative NMOSD [DN-NMOSD], 61 myelin oligodendrocyte glycoprotein antibody-associated disease [MOGAD], 64 clinically isolated syndrome [CIS], 237 relapsing-remitting MS [RRMS], and 162 primary progressive MS [PPMS]). The association between log[sNFL] and log[sGFAP] and age, sex, time since relapse, EDSS, oligoclonal bands, and MRI characteristics was analyzed by multiple linear regression. The diagnostic performance of sNfL and sGFAP in discriminating between NMOSD and MS subgroups was evaluated using multivariable logistic regression and area under the curve (AUC). Results: For each group, specific associations of sNFL and sGFAP levels with patient characteristics were observed. Clearest associations were observed in AQP4-NMOSD patients. After a recent attack (≤ 90 days), multivariate analysis revealed that sGFAP and age discriminated AQP4-NMOSD from MOGAD (AUC = 0.939 [0.910;0.982]), AQP4-NMOSD and DN-NMOSD from MOGAD (AUC = 0.863 [0.776;0.977]), and AQP4-NMOSD from all other groups (AUC = 0.950 [0.918;0.987]). Diagnostic probability heatmaps based on sGFAP and age illustrate the probability of each diagnosis relative to others for bedside interpretation. Conclusion: After an acute attack of NMOSD, risk score based on sGFAP and age may guide the management of patients before autoantibody status is available.
SN - 1351-5101
SN - 1468-1331
ER -