A commercially available multi-analyte blood test was associated with MRI evidence of acute disease activity in people with relapsing-remitting multiple sclerosis (RRMS), according to a retrospective observational study published in Neurology and Therapy.

Investigators evaluated results of the Octave Multiple Sclerosis Disease Activity (MSDA) Test (Octave Bioscience, Menlo Park, CA) in 66 individuals with RRMS treated at a single academic neuroimmunology clinic. The study included 33 individuals evaluated for acute neurologic symptoms that are concerning for relapse and 33 individuals undergoing routine disease surveillance. All participants had paired MSDA Test and MRI results obtained before glucocorticoid exposure or other acute treatment.

The MSDA Test is an 18-protein blood-based assay that generates a composite Disease Activity Score (DAS), categorized as low, moderate, or high disease activity. Investigators compared DAS results with MRI evidence of gadolinium-enhancing lesions and also assessed whether the multi-analyte approach predicted MRI-confirmed disease activity more accurately than neurofilament light chain (NfL) alone.

Key results include the following:

  • Among individuals with acute neurologic symptoms, MSDA testing was performed before MRI in 79% of cases.
  • In the acute symptom cohort, gadolinium-enhancing lesions were identified in 10 individuals.
  • A DAS threshold of >6.0 to 10.0 had 100.00% sensitivity, 94.00% specificity, 84.21% positive predictive value, 100.00% negative predictive value, and 95.45% accuracy for predicting gadolinium-enhancing lesions.
  • A DAS threshold of >6.5 to 10.0 had 87.50% sensitivity, 96.00% specificity, 87.50% positive predictive value, 96.00% negative predictive value, and 93.94% accuracy, according to a published correction to the original article.
  • The composite DAS predicted gadolinium enhancement more accurately than NfL alone, with an area under the curve of 98.06% compared with 82.75% for NfL (P=.0061).
  • Individuals with gadolinium enhancement had higher concentrations of myelin oligodendrocyte glycoprotein (P=.013) and NfL (P<.0001), as well as lower levels of B-cell activating factor (P<.0001).

The authors suggested that multi-protein blood-based testing may help identify biologic activity associated with MRI-confirmed relapse and may be useful when clinicians are evaluating new symptoms that could represent either inflammatory relapse or pseudoexacerbation.

The study’s findings should be interpreted with caution. The analysis was retrospective, included a small cohort from a single academic center, and did not adjust for multiple testing. The authors also noted that body mass index and renal function were not available, which may be relevant when interpreting NfL concentrations.

Source: Okuda DT, Moog TM, McCreary MC, et al. Utility of multi-analyte protein assay to distinguish multiple sclerosis clinical relapse from pseudoexacerbation. Neurol Ther. Published online 2026. doi:10.1007/s40120-026-00984-2

Correction: Okuda DT, Moog TM, McCreary MC, et al. Correction: Utility of multi-analyte protein assay to distinguish multiple sclerosis clinical relapse from pseudoexacerbation. Neurol Ther. Published online 2026. doi:10.1007/s40120-026-01005-y