Use of blood-based neurofilament light chain as an endpoint in clinical trials of neurodegenerative conditions: a scoping review

Zheng, Y; Bhalala, OG; Chin, KS; Watson, R; Yassi, N

Author(s): Zheng, Y; Bhalala, OG; Chin, KS; Watson, R; Yassi, N;
Details: Publication Year 2026-07-20,Volume 273,Issue #8,Page 476
Journal Title: Journal of Neurology
Abstract: INTRODUCTION: Neurofilament light chain (NfL) is a structural axonal protein measurable in CSF and blood, increasingly investigated as a biomarker of neuroaxonal injury in clinical and research contexts. This review aims to explore the use of blood-based NfL as an endpoint in clinical trials of neurodegenerative conditions. METHOD: A database search of MEDLINE and EMBASE was conducted to identify interventional clinical trials and/or related post hoc analyses for neurodegenerative diseases, published between 2013 and 2024 that reported the use of serum or plasma NfL as an endpoint. Additional studies from reference lists of included trials were manually considered for inclusion where relevant. Data were charted descriptively by disease type and summarised. RESULTS: 49 studies were included, 29 in multiple sclerosis (MS), eight in amyotrophic lateral sclerosis (ALS), six in Alzheimer's disease (AD), and six in other diseases. Across studies, reductions in NfL often paralleled improvements in primary efficacy outcomes, supporting its use as a biomarker of disease activity and treatment response. However, several studies demonstrated a lack of concordance between change in NfL and in clinical outcomes, some of which may be related to the non-disease-modifying mechanisms of the interventions studied. This necessitates careful consideration when applying blood-based NfL as a biomarker endpoint for studies involving such interventions. CONCLUSION: Blood NfL is a promising biomarker with potential utility as a surrogate endpoint in neurological clinical trials, particularly for diseases with active axonal injury. Further validation, particularly around disease- and intervention-specific interpretation, is needed before blood NfL can be incorporated more routinely as a clinical endpoint.
Publisher: Springer
Keywords: Humans; *Neurofilament Proteins/blood; *Neurodegenerative Diseases/blood/diagnosis; Biomarkers/blood; *Clinical Trials as Topic; Blood biomarkers; Clinical trials; Neurodegenerative diseases; Neurofilament light; NfL; Plasma biomarkers; Serum biomarkers
Research Division(s): Genetics and Gene Regulation
PubMed ID: 42474734
Publisher's Version: https://doi.org/10.1007/s00415-026-14007-5
Open Access at Publisher's Site: https://doi.org/10.1007/s00415-026-14007-5
Terms of Use/Rights Notice: Refer to copyright notice on published article.

Creation Date: 2026-07-23 11:46:52

Last Modified: 2026-07-23 11:47:01