Prognostic value of neurofilament light chain in natalizumab therapy for different phases of multiple sclerosis: A systematic review and meta-analysis

A systematic review and meta-analysis of the prognostic value of neurofilament light chain levels in multiple sclerosis treatment with natalizumab Relevant studies published before January 2022 were retrieved from the PubMed, Web of Science, and clinicaltrials.gov databases. Qualitative analysis and meta-analysis were included in 7 of the 46 papers. Differences in the Neurofilament light chain levels were used as the main efficacy measures, and the meta-analysis was performed using Review Manager version 5.3 software. Seven clinical trials were selected. Neurofilament light chain levels were lower in the 947 patients on natalizumab treatment than the 959 patients before therapy, with a moderate effect size of 0.73 (p < 0.00001). Mean Neurofilament light chain levels showed no significant difference between the remitting and relapsing phase of MS before and after natalizumab treatment. The EDSS scores of 41 MS patients in the relapsing phase after natalizumab treatment were significantly lower than those in 102 MS patients without therapy (MD = -0.45;95% CI = -0.85 to -0.05;P < 0.001). However, the EDSS scores in the remitting phase demonstrated no difference. The comparison of Neurofilament light chain across multiple groups demonstrates the potential of Nfl as a noninvasive biomarker of neurodegeneration, evaluating the efficacy of natalizumab in MS patients. We also investigated the relationship between different phases of relapsing-remitting MS with Neurofilament light chain levels. However, the value of Neurofilament light chain as a biomarker was hard to assess due to the limited number of studies. For clinical application, a comprehensive understanding of Neurofilament light chain concentrations in disease subtypes is required, and disease stages should be defined to develop standardized criteria.