TRICALS risk score augments but cannot replace neurofilament as a prognostic biomarker in ALS.
Ahmad Al Khleifat, Andrea Malaspina, Janine Kirby et al.
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In 30 seconds
This randomized controlled trial evaluated the TRICALS risk score as a prognostic tool in amyotrophic lateral sclerosis (ALS) using data from the MIROCALS trial (n = 220). The study found that while the TRICALS risk score moderately correlated with CSF neurofilament biomarkers, it could not replace them in predicting survival outcomes. The hazard ratio for the TRICALS × treatment interaction was 0.72.
Key findings
- TRICALS risk score moderately correlated with CSF pNFH (r = 0.357), explaining 12.7% of shared variance.
- Substituting CSF pNFH with TRICALS score reduced model performance (-2LL 928.25 vs 793.36).
- The pNFH × treatment interaction significantly improved model fit (Δχ2 = 14.24) compared to TRICALS × treatment interaction (Δχ2 = 4.76).
- Identified treatment effect with pNFH (HR 0.28, 95% CI 0.12-0.63; p = 0.002).
Why it matters
Understanding the limitations of the TRICALS risk score in ALS prognosis is crucial for clinicians. It highlights the importance of neurofilament biomarkers in clinical trial design and patient stratification, ensuring more accurate predictions of survival and treatment responses.