Liampas Andreas, Tseriotis Vasilis-Spyridon, Mavridis Theodoros, Vavougios George D, Zis Panagiotis, Hadjigeorgiou Georgios M, Bargiotas Panagiotis, Pourzitaki Chryssa, Artemiadis Artemios
Department of Neurology, Nicosia General Hospital, Nicosia Limassol Old Road 215, P.C. 2029, Strovolos, Nicosia, Cyprus.
"Agios Pavlos" General Hospital of Thessaloniki, 161 Ethnikis Antistaseos Leof., P.C. 55134, 12 Kalamaria, Thessaloniki, Greece.
Neurol Sci. 2025 Apr;46(4):1541-1553. doi: 10.1007/s10072-024-07930-w. Epub 2024 Dec 14.
Oligoclonal bands (OCBs) in cerebrospinal fluid (CSF) are utilized for diagnosing multiple sclerosis (MS), as they are found in 95% of patients. Additionally, OCBs are linked to disease prognosis. The primary contributors to OCB production are long-lived plasma cells. This study aims to quantify the impact of natalizumab (NTZ) on OCB levels in the CSF of MS patients.
A systematic search on MEDLINE, SCOPUS and Web of Science for English-written and peer-reviewed longitudinal studies on adults was performed. Methodological quality was assessed with the Newcastle-Ottawa Scale. Proportional meta-analysis was performed in R using a generalized linear mixed-effects model. We investigated heterogeneity with influence diagnostics, sensitivity analysis and meta-regression.
Eight eligible studies of adequate quality with a total sample of 326 relapsing-remitting MS patients were included. A summary rate of 14.07% [95% CI, 4.48%-36.36%] for complete loss of OCBs and 42.02% [95% CI, 15.23%-74.51%] for reduction in OCB number or intensity was observed, both with considerable heterogeneity. Pooled estimates dropped (11% [95% CI, 0.04%-0.29%] and 34% [95% CI, 0.11%-0.68%] respectively) after the identification of an influential study. Multivariable meta-regression identified IgG index as a factor contributing to heterogeneity (adj. p = 0.0279), regarding reduction of OCB number or intensity.
In conclusion, our systematic review and meta-analysis showed that NTZ can lead to reduction of intrathecal OCBs in MS patients, indicating a possible effect of NTZ on memory plasma cells, which are the main source of OCBs in MS.
脑脊液（CSF）中的寡克隆带（OCBs）可用于诊断多发性硬化症（MS），因为95%的患者中可检测到OCBs。此外，OCBs与疾病预后相关。OCBs产生的主要来源是长寿浆细胞。本研究旨在量化那他珠单抗（NTZ）对MS患者脑脊液中OCB水平的影响。
在MEDLINE、SCOPUS和Web of Science上对英文撰写且经过同行评审的关于成年人的纵向研究进行系统检索。采用纽卡斯尔-渥太华量表评估方法学质量。在R中使用广义线性混合效应模型进行比例荟萃分析。我们通过影响诊断、敏感性分析和荟萃回归研究异质性。
纳入了八项质量合格的研究，总样本为326例复发缓解型MS患者。观察到OCBs完全消失的汇总率为14.07%[95%置信区间，4.48%-36.36%]，OCB数量或强度降低的汇总率为42.02%[95%置信区间，15.23%-74.51%]，两者均存在相当大的异质性。在识别出一项有影响力的研究后，合并估计值下降（分别为11%[95%置信区间，0.04%-0.29%]和34%[95%置信区间，0.11%-0.68%]）。多变量荟萃回归确定IgG指数是导致OCB数量或强度降低的异质性因素（调整后p = 0.0279）。
总之，我们的系统评价和荟萃分析表明，NTZ可导致MS患者鞘内OCBs减少，这表明NTZ可能对记忆浆细胞有影响，而记忆浆细胞是MS中OCBs的主要来源。
