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74±1.66pg/mL vs. 43.96±12.87pg/mL, p=0.0136) and at 3-month follow-up (28.40±3.39pg/mL vs. 40.33±5.44pg/mL, p=0.0356). In this study, we found exosomal TDP-43 ratio was increasing along with follow-up at 3 and 6months and NFL levels in plasma was associated with rapid progression in ALS patients. In addition to NFL, exosomal TDP-43 ratio might be a potential candidate of biomarkers for ALS long-term follow-up studies. In this study, we found exosomal TDP-43 ratio was increasing along with follow-up at 3 and 6 months and NFL levels in p