Neurofilaments in progressive multiple sclerosis: a systematic review.

Area of Science:

• Neuroscience
• Biomarker Research
• Neurology

Background:

• Neurofilament proteins are established biomarkers in relapsing-remitting multiple sclerosis.
• Their utility in progressive multiple sclerosis (MS) requires further clarification.
• There is a critical need for reliable biomarkers in progressive MS.

Purpose of the Study:

• To systematically review the literature on neurofilament light (NFL) and neurofilament heavy (NFH) in progressive multiple sclerosis.
• To address key questions regarding their role as biomarkers in this condition.

Main Methods:

• A systematic search of major scientific databases (PubMed, Embase, Web of Science, Scopus) was conducted.
• 76 relevant sources were qualitatively reviewed using QUADAS-2 criteria.
• 17 studies identified as low risk of bias were analyzed separately.

Main Results:

• NFL is consistently associated with neuroinflammation and future brain atrophy in progressive MS.
• NFL serves as a marker for treatment response to immunosuppressive therapies.
• Associations between NFL and disability are inconsistent; no evidence supports NFL as a marker for neuroprotective treatments.
• Evidence for NFH is limited and inconsistent.

Conclusions:

• Neurofilament light demonstrates consistent utility as a biomarker for neuroinflammation, brain atrophy, and response to immunosuppressive treatments at a group level.
• Neither NFL nor NFH consistently indicate treatment response to neuroprotective therapies.
• Further data from randomized controlled trials are needed to evaluate neuroprotective treatments.