神经纤维光链作为多发性硬化症 (LUMINOUS) 疾病活动的替代候选人-随机对照试验的元回归
Roxanne Pretzsch1, Sahla El Mahdaoui2, Poljanka Johnson3
1Multiple Sclerosis Centre, Departments of Neurology, Clinical Research and Biomedicine, University Hospital Basel and University of Basel, Switzerland; Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Switzerland; Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Switzerland.
神经纤维光链 (NfL) 在多发性硬化症 (MS) 临床试验中显示了对复发率,MRI病变和残疾恶化的治疗效果的中度关联. 然而,没有发现与大脑体积变化有一致的联系.
科学领域:
- 神经免疫学 神经免疫学
- 生物标志物研究 生物标志物研究
- 临床试验方法论 临床试验方法论
背景情况:
- 神经纤维光链 (NfL) 是监测多发性硬化症 (MS) 疾病活动和治疗疗效的新兴生物标志物.
- 血清/血NfL (s/pNfL) 水平反映了MS中神经轴突损伤.
- 了解s/pNfL变化与临床/放射学结果之间的相关性对于治疗评估至关重要.
研究的目的:
- 在MS随机对照试验 (RCT) 中进行元回归分析,评估治疗对s/pNfL的影响与关键临床和放射性终点之间的关系.
- 评估s/pNfL变化与年复发率 (ARR),确认残疾恶化 (CDW),MRI T2病变和大脑体积变化之间的关联强度.
主要方法:
- 系统的PubMed搜索在1999年至2023年期间发表的MS RCT,至少持续24个月,并提供s/pNfL数据.
- 提取对s/pNfL,ARR,CDW,新的/扩大的MRI T2病变和百分比大脑体积变化 (PBVC) 的治疗效应.
- 以试验规模和持续时间加权的元回归分析,以评估治疗对s/pNfL和其他结果的影响之间的关联.
主要成果:
- 包括15个RCT (n=6814),包括9个复发性MS (RMS) 和6个进展性MS (PMS).
- 治疗对s/pNfL的影响显示了对MRI新/扩大的T2病变 (R2=0.42,p=0.01),ARR (R2=0.33,p=0.03),CDW (R2=0.30,p=0.04) 的治疗效应的中度关联.
- 在s/pNfL治疗效果和PBVC之间没有发现显著的关联. 在仅针对RMS的试验中,与ARR和CDW的关联更为明显.
结论:
- 在MS中,治疗引起的s/pNfL变化与ARR,MRI T2病变和CDW的治疗效应中度相关.
- s/pNfL作为与炎症和轴突损伤相关的治疗反应的潜在代用标记.
- 在这个元回归中,s/pNfL与对大脑体积变化 (PBVC) 的治疗效应之间的关联并未一致观察到.
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