Multiple sclerosis: meta-analysis suggests utility of NfL for monitoring

  • Martin SJ & al.
  • J Neurol Neurosurg Psychiatry
  • 23 May 2019

  • International Clinical Digest
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Takeaway

  • Cerebrospinal fluid (CSF) levels of neurofilament light chain (NfL) protein correlated with disease activity throughout the course of multiple sclerosis (MS).
  • Elevated levels were more strongly associated with relapse (inflammatory disease activity) than with progression.

Why this matters

  • Role of NfL levels in clinical practice is unclear.

Key results

  • Mean CSF levels of NfL were higher in patients with MS than in unaffected controls (1965.8 vs 578.3 ng/L; effect size, 0.61; P<.00001>
  • Among patients with MS, mean CSF levels of NfL higher:
    • In those with relapsing disease vs progressive disease (2124.8 vs 1121.4 ng/L; P=.0108).
    • In those having a relapse (irrespective of MS subtype) vs those in remission (3080.6 vs 1541.7 ng/L; P<.0001>
  • Levels did not differ significantly between treated vs untreated MS or between primary vs secondary progressive MS.

Study design

  • Systematic review and meta-analysis of 20 case-control studies:
    • 746 patients with MS.
    • 435 control individuals without MS (103 healthy, 332 with noninflammatory neurologic diseases).
  • Main outcome: CSF levels of NfL.
  • Funding: None disclosed.

Limitations

  • Single author reviewed literature.
  • Studies with insufficient data excluded.
  • Use of raw data uncorrected for age.

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