The following is a summary of the “Prognostic significance of neurofilament light in Fingolimod therapy for Multiple Sclerosis: A systemic review and meta-analysis based on randomized control trials,” published in the January 2023 issue of Multiple Sclerosis and Related Disorders by Ashkar, et al.
The goal of this study was to evaluate the role of plasma levels of Neurofilament light chain (NfL) as a prognostic factor for Multiple Sclerosis and to determine the influence of Fingolimod on NfL. PubMed/Medline, the Cochrane Library, and Google Scholar were searched systematically from their start dates until September 7th, 2022. Review Manager version 5.4.1 was utilised for all statistical testing. A subset of studies that met the inclusion criteria were chosen. Only trials with MS patients whose plasma levels of NfL were reported and Fingolimod was administered in the therapy group were considered.
The prognostic value of NfL was evaluated using a fixed-effects model and the results were provided as the Hazards ratio (HR) and 95% CI. Moreover, qualitative analysis of the impact of Fingolimod on NfL levels was performed. In total, 5 RCTs were included for analysis. Quantitative analysis of 4 studies found that an increase in NfL was associated with a substantial rise in the worsening of cognitive handicap (HR= 1.66 [1.35, 2.05]; P< 0.00001; I2= 0%). Factors associated with elevated NfL levels in MS patients were analyzed using a qualitative analysis approach.
Throughout 5 studies, Fingolimod was found to significantly reduce NfL levels compared to a placebo. Increases in NfL levels were linked to an increased risk of recurrence, active/new T2 lesions, and a greater proportion of brain volume change, as determined by a meta-analysis of 4 studies correlating NfL levels with clinical and MRI data. Their systematic review and meta-analysis showed that when Fingolimod was used to treat MS, NfL levels dropped dramatically, providing strong evidence for NfL’s utility as a prognostic marker.
Source: sciencedirect.com/science/article/abs/pii/S2211034822009208
