Contributions
Abstract: EP1594
Type: ePoster
Abstract Category: Pathology and pathogenesis of MS - 25 Biomarkers
Background: Cerebrospinal fluid (CSF) oligoclonal IgM bands (IgMOB) have been linked to a shorter first-inter attack interval and to a more aggressive disease course in Multiple Sclerosis (MS) patients. Some recent studies [1-2], however, did not confirm this data.
Objective: Aim of the study was to assess the prognostic role of CSF IgMOB over time and in relation to the introduction of disease-modifying drugs (DMD).
Methods: We pooled and updated information on patients included in previous studies on CSF IgMOB and divided them in two groups, depending on whether the disease onset had occurred before or in/after 1995, year in which the first DMD became available in Italy.
Results: We studied 336 patients (220F) who had carried out a spinal tap between 1984 and 2011 and who were followed up for a median of 13 years (IQR: 8-19) from onset. Ninety-one percent of patients with disease onset prior to 1995 (63/69) had not been treated in the first two years as opposed to 49% (131/267) of those with onset in/after 1995 (p< 0.001). The presence of CSF IgMOB significantly increased the odds of reaching an EDSS of 3, 4 and 6 (OR: 4.7, 5.7 and 7.1, respectively) only in patients with disease onset prior to 1995.
Discussion: Our results may be explained by the efficacy of DMD in modifying the disease course, although we must point out that the older cohort carried out the spinal tap after a longer median interval from onset (12 months versus 1 month). IgMOB-positive patients in the older group may, therefore, hypothetically, be more likely to have persistent IgM responses (associated with lipid-specific IgMOB and a more aggressive disease course), while in the more recent cohort we may have included more IgMOB-positive patients with transient IgM responses.
Conclusion: CSF IgMOB were predictive of higher long-term disability only in patients with MS onset prior to the treatment era and with a longer onset-spinal tap interval.
1. Ferraro D, Galli V, Vitetta F, et al. (2015) Cerebrospinal fluid CXCL13 in clinically isolated syndrome patients: Association with oligoclonal IgM bands and prediction of Multiple Sclerosis diagnosis. J Neuroimmunol 283:64-9.
2. Frau J, Coghe G, Lorefice L, et al. (2016) Intrathecal IgM synthesis: is really a prognostic factor? Neurol Sci 37:S260-1.
Disclosure:
Diana Ferraro has received travel grants and/or speaker honoraria from Merck Serono, Biogen, Novartis, TEVA and Sanofi-Genzyme.
Patrizia Sola has received travel grants and/or speaker honoraria from Merck Serono, Biogen, Novartis, TEVA and Sanofi-Genzyme.
Anna Maria Simone has received travel grants and/or speaker honoraria from Merck Serono, Biogen, Novartis, TEVA and Sanofi-Genzyme.
Paolo Frigio Nichelli has nothing to disclose.
Roberta Bedin has nothing to disclose.
Valentina Camera has nothing to disclose.
Abstract: EP1594
Type: ePoster
Abstract Category: Pathology and pathogenesis of MS - 25 Biomarkers
Background: Cerebrospinal fluid (CSF) oligoclonal IgM bands (IgMOB) have been linked to a shorter first-inter attack interval and to a more aggressive disease course in Multiple Sclerosis (MS) patients. Some recent studies [1-2], however, did not confirm this data.
Objective: Aim of the study was to assess the prognostic role of CSF IgMOB over time and in relation to the introduction of disease-modifying drugs (DMD).
Methods: We pooled and updated information on patients included in previous studies on CSF IgMOB and divided them in two groups, depending on whether the disease onset had occurred before or in/after 1995, year in which the first DMD became available in Italy.
Results: We studied 336 patients (220F) who had carried out a spinal tap between 1984 and 2011 and who were followed up for a median of 13 years (IQR: 8-19) from onset. Ninety-one percent of patients with disease onset prior to 1995 (63/69) had not been treated in the first two years as opposed to 49% (131/267) of those with onset in/after 1995 (p< 0.001). The presence of CSF IgMOB significantly increased the odds of reaching an EDSS of 3, 4 and 6 (OR: 4.7, 5.7 and 7.1, respectively) only in patients with disease onset prior to 1995.
Discussion: Our results may be explained by the efficacy of DMD in modifying the disease course, although we must point out that the older cohort carried out the spinal tap after a longer median interval from onset (12 months versus 1 month). IgMOB-positive patients in the older group may, therefore, hypothetically, be more likely to have persistent IgM responses (associated with lipid-specific IgMOB and a more aggressive disease course), while in the more recent cohort we may have included more IgMOB-positive patients with transient IgM responses.
Conclusion: CSF IgMOB were predictive of higher long-term disability only in patients with MS onset prior to the treatment era and with a longer onset-spinal tap interval.
1. Ferraro D, Galli V, Vitetta F, et al. (2015) Cerebrospinal fluid CXCL13 in clinically isolated syndrome patients: Association with oligoclonal IgM bands and prediction of Multiple Sclerosis diagnosis. J Neuroimmunol 283:64-9.
2. Frau J, Coghe G, Lorefice L, et al. (2016) Intrathecal IgM synthesis: is really a prognostic factor? Neurol Sci 37:S260-1.
Disclosure:
Diana Ferraro has received travel grants and/or speaker honoraria from Merck Serono, Biogen, Novartis, TEVA and Sanofi-Genzyme.
Patrizia Sola has received travel grants and/or speaker honoraria from Merck Serono, Biogen, Novartis, TEVA and Sanofi-Genzyme.
Anna Maria Simone has received travel grants and/or speaker honoraria from Merck Serono, Biogen, Novartis, TEVA and Sanofi-Genzyme.
Paolo Frigio Nichelli has nothing to disclose.
Roberta Bedin has nothing to disclose.
Valentina Camera has nothing to disclose.