Contributions
Abstract: EP1615
Type: ePoster
Abstract Category: Pathology and pathogenesis of MS - 25 Biomarkers
Background: Detection of intrathecal immunoglobulin G (IgG) synthesis indicated by oligoclonal bands (OCBs) or in the Reiber diagram are well established markers for acute and chronic inflammation in the central nervous system (CNS). Especially OCBs are connected to a more severe disease course in multiple sclerosis (MS). In the last years also IgM OCBs gained impact and were associated with a worse clinical outcome if present, particularly in the progressive forms of MS. However, the detection of IgM OCBs is challenging and conformation of those findings by several independent groups is still pending. In this study we compared the predictive values of IgG OCBs, intrathecal IgG and IgM production towards conversion of CIS patients to definite MS.
Methods: We retrospectively collected data of IgG OCBs, intrathecal IgG and IgM production as indicated by the Reiber diagram of CIS patients who attended university hospital of Ulm during their very first relapse as well as clinical data such as extended disability status scale (EDSS) and time to conversion to MS (CTM) in months.
Results: 50 patients were included of whom 60 % were female and the median age was 34 (IQR 23-45). The median follow up time was 35 months (IQR 24-46), whereas in this time 48 % converted to clinical definite MS. 80 % of the patients showed a positive OCB finding, 28 % an intrathecal IgG and 18 % an intrathecal IgM production.
There was no correlation of the numerical quotients for IgG and IgM to EDSS (p= 0.43 and 0.37, respectively) but EDSS levels were significantly higher in IgG OCB positive compared to OCB negative patients (p= 0.016).
The hazard ratio for conversion was highest for patients showing an intrathecal IgM production (HR 2.5 compared to 2.1 for intrathecal IgG production and 2.0 for OCB positivity). Furthermore, 89 % (8 of 9) patients with an intrathecal IgM production did convert to a definite MS, whereas the conversion prevalence for OCB positive subjects was 64 % and 75 % for patients with an intrathecal IgG production according to the Reiber diagram.
Discussion: Our data suggest that an intrathecal IgM production indicated by the Reiber diagram is a more specific risk marker for conversion than e.g. OCBs, nevertheless OCBs are still superior concerning sensitivity and are related with a higher EDSS in our study. This finding has to be confirmed by a larger study and should also be compared to IgM OCBs to see whether those two findings are comparable or independent of each other.
Disclosure: A.H.: nothing to disclose
A.A.: nothing to disclose
F.B.: nothing to disclose
S.H.: nothing to disclose
M.S. has received honoraria for lecturing and/or travel expenses for attending meetings from Bayer, Biogen Idec and TEVA.
M.O.: nothing to disclose
H.T.: nothing to disclose
Abstract: EP1615
Type: ePoster
Abstract Category: Pathology and pathogenesis of MS - 25 Biomarkers
Background: Detection of intrathecal immunoglobulin G (IgG) synthesis indicated by oligoclonal bands (OCBs) or in the Reiber diagram are well established markers for acute and chronic inflammation in the central nervous system (CNS). Especially OCBs are connected to a more severe disease course in multiple sclerosis (MS). In the last years also IgM OCBs gained impact and were associated with a worse clinical outcome if present, particularly in the progressive forms of MS. However, the detection of IgM OCBs is challenging and conformation of those findings by several independent groups is still pending. In this study we compared the predictive values of IgG OCBs, intrathecal IgG and IgM production towards conversion of CIS patients to definite MS.
Methods: We retrospectively collected data of IgG OCBs, intrathecal IgG and IgM production as indicated by the Reiber diagram of CIS patients who attended university hospital of Ulm during their very first relapse as well as clinical data such as extended disability status scale (EDSS) and time to conversion to MS (CTM) in months.
Results: 50 patients were included of whom 60 % were female and the median age was 34 (IQR 23-45). The median follow up time was 35 months (IQR 24-46), whereas in this time 48 % converted to clinical definite MS. 80 % of the patients showed a positive OCB finding, 28 % an intrathecal IgG and 18 % an intrathecal IgM production.
There was no correlation of the numerical quotients for IgG and IgM to EDSS (p= 0.43 and 0.37, respectively) but EDSS levels were significantly higher in IgG OCB positive compared to OCB negative patients (p= 0.016).
The hazard ratio for conversion was highest for patients showing an intrathecal IgM production (HR 2.5 compared to 2.1 for intrathecal IgG production and 2.0 for OCB positivity). Furthermore, 89 % (8 of 9) patients with an intrathecal IgM production did convert to a definite MS, whereas the conversion prevalence for OCB positive subjects was 64 % and 75 % for patients with an intrathecal IgG production according to the Reiber diagram.
Discussion: Our data suggest that an intrathecal IgM production indicated by the Reiber diagram is a more specific risk marker for conversion than e.g. OCBs, nevertheless OCBs are still superior concerning sensitivity and are related with a higher EDSS in our study. This finding has to be confirmed by a larger study and should also be compared to IgM OCBs to see whether those two findings are comparable or independent of each other.
Disclosure: A.H.: nothing to disclose
A.A.: nothing to disclose
F.B.: nothing to disclose
S.H.: nothing to disclose
M.S. has received honoraria for lecturing and/or travel expenses for attending meetings from Bayer, Biogen Idec and TEVA.
M.O.: nothing to disclose
H.T.: nothing to disclose