Contributions
Abstract: 95
Type: Oral
Abstract Category: Clinical aspects of MS - 1 Diagnosis and differential diagnosis
Background: Evidence exists that presence of oligoclonal bands (OB) in typical clinically isolated syndromes (CIS) increases the risk of a second attack independently of magnetic resonance imaging (MRI) findings.
Goals: To explore the added value of OB for multiple sclerosis (MS) diagnosis in the context of the 2010 McDonald criteria.
Methods: Study based on an ongoing CIS cohort. MRIs were obtained 3-5 months after the CIS, at one year and every five years. OB were determined by isoelectric focusing combined with immunoblotting. We selected 565 patients with OB determination and sufficient data on baseline brain MRI to assess 2010 dissemination in space (DIS) and time (DIT) considering the symptomatic lesions. We excluded 167 (29.6%) already fulfilling DIS and DIT and divided the remaining 398 into no DIS no DIT (n=218), DIS only (n=164) and DIT only (n=16). We performed Cox proportional hazards regression models with 2010 McDonald as the outcome, using no DIS no DIT with 0 lesions (n=107) as the reference for: no DIS no DIT with ≥1 lesion, DIS only (both groups divided according to OB status), and DIT only. To assess performance, we further selected cases with a follow-up ≥3 years or a second attack within 3 years of the CIS (n=305), also divided into no DIS no DIT (n=165), DIS only (n=129) and DIT only (n=11), and classifying no DIS no DIT with ≥1 lesion (n=93) and DIS only according to OB status. We assessed sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value with 2010 McDonald at 3 years as the outcome.
Results: The baseline characteristics were in line with those previously described in our cohort. The adjusted hazard ratios (aHR, 95% CI) were 2.8 (1.3-6.1) for no DIS no DIT with ≥1 lesion and negative OB, 6.4 (3.2-12.6) for no DIS no DIT with ≥1 lesion and positive OB, 9.7 (4.8-19.7) for DIS only with negative OB, 14.8 (7.9-27.8) for DIS only with positive OB, and 7.9 (3.2-19.2) for DIT only. Regarding performance, specificity was 77.6 for no DIS no DIT with ≥1 lesion and negative OB, 89.1 for no DIS no DIT with ≥1 lesion and positive OB, 92.5 for DIS only and negative OB, 88.1 for DIS only and positive OB, and 97.8 for DIT only. DIS only with positive OB had the highest sensitivity (46.2), accuracy (64.6) and PPV (83.2).
Conclusions: According to these results, we propose MRI DIS at any time plus positive OB as an additional criterion for MS diagnosis.
Disclosure: G Arrambide has received compensation for consulting services from Biogen-Idec, research support from Novartis, and speaking honoraria from Sanofi-Aventis.
M Tintore has received compensation for consulting services and speaking honoraria from Bayer Schering Pharma, Merck-Serono, Biogen-Idec, Teva Pharmaceuticals, Sanofi-Aventis, Novartis, Almirall, Genzyme, and Roche. Ç
C Espejo reports no disclosures.
M Castillo reports no disclosures.
C Auger has received speaking honoraria from Novartis, Biogen and Stendhal.
J Río has received speaking honoraria and personal compensation for participating on Advisory Boards from Almirall, Bayer-Schering Healthcare, Biogen-Idec, Genzyme, Merck-Serono, Novartis, Teva, and Sanofi-Aventis.
J Castilló reports no disclosures.
A Vidal-Jordana has received speaking honoraria and consulting fees from Novartis, Roche, and Sanofi-Aventis.
I Galán reports no disclosures.
C Nos reports no disclosures.
M Comabella has received compensation for consulting services and speaking honoraria from Bayer Schering Pharma, Merk Serono, Biogen-Idec, Teva Pharmaceuticals, Sanofi-Aventis, and Novartis.
R Mitjana reports no disclosures.
P Mulero reports no disclosures.
A de Barros reports no disclosures.
B Rodríguez-Acevedo reports no disclosures.
L Midaglia reports no disclosures.
J Sastre-Garriga has received compensation for participating on Advisory Boards, speaking honoraria and travel expenses for scientific meetings, consulting services or research support from Novartis, Biogen, Serono Symposia International Foundation, Merck, Almirall, and Genzyme.
A Rovira serves on scientific advisory boards for Biogen Idec, Novartis, Genzyme, and OLEA Medical, and on the editorial board of the American Journal of Neuroradiology, Neuroradiology and European Radiology, has received speaker honoraria from Bayer, Genzyme, Sanofi-Aventis, Bracco, Merck-Serono, Teva Pharmaceutical Industries Ltd, OLEA Medical, Stendhal, Novartis and Biogen Idec, and has research agreements with Siemens AG.
X Montalban has received speaking honoraria and travel expenses for participation in scientific meetings, has been a steering committee member of clinical trials or participated in advisory boards of clinical trials in the past with Actelion, Amirall, Bayer, Biogen, Celgene, Genzyme, Hoffmann-La Roche, Novartis, Oryzon Genomics, Sanofi-Genzyme and Teva Pharmaceutical.
Abstract: 95
Type: Oral
Abstract Category: Clinical aspects of MS - 1 Diagnosis and differential diagnosis
Background: Evidence exists that presence of oligoclonal bands (OB) in typical clinically isolated syndromes (CIS) increases the risk of a second attack independently of magnetic resonance imaging (MRI) findings.
Goals: To explore the added value of OB for multiple sclerosis (MS) diagnosis in the context of the 2010 McDonald criteria.
Methods: Study based on an ongoing CIS cohort. MRIs were obtained 3-5 months after the CIS, at one year and every five years. OB were determined by isoelectric focusing combined with immunoblotting. We selected 565 patients with OB determination and sufficient data on baseline brain MRI to assess 2010 dissemination in space (DIS) and time (DIT) considering the symptomatic lesions. We excluded 167 (29.6%) already fulfilling DIS and DIT and divided the remaining 398 into no DIS no DIT (n=218), DIS only (n=164) and DIT only (n=16). We performed Cox proportional hazards regression models with 2010 McDonald as the outcome, using no DIS no DIT with 0 lesions (n=107) as the reference for: no DIS no DIT with ≥1 lesion, DIS only (both groups divided according to OB status), and DIT only. To assess performance, we further selected cases with a follow-up ≥3 years or a second attack within 3 years of the CIS (n=305), also divided into no DIS no DIT (n=165), DIS only (n=129) and DIT only (n=11), and classifying no DIS no DIT with ≥1 lesion (n=93) and DIS only according to OB status. We assessed sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value with 2010 McDonald at 3 years as the outcome.
Results: The baseline characteristics were in line with those previously described in our cohort. The adjusted hazard ratios (aHR, 95% CI) were 2.8 (1.3-6.1) for no DIS no DIT with ≥1 lesion and negative OB, 6.4 (3.2-12.6) for no DIS no DIT with ≥1 lesion and positive OB, 9.7 (4.8-19.7) for DIS only with negative OB, 14.8 (7.9-27.8) for DIS only with positive OB, and 7.9 (3.2-19.2) for DIT only. Regarding performance, specificity was 77.6 for no DIS no DIT with ≥1 lesion and negative OB, 89.1 for no DIS no DIT with ≥1 lesion and positive OB, 92.5 for DIS only and negative OB, 88.1 for DIS only and positive OB, and 97.8 for DIT only. DIS only with positive OB had the highest sensitivity (46.2), accuracy (64.6) and PPV (83.2).
Conclusions: According to these results, we propose MRI DIS at any time plus positive OB as an additional criterion for MS diagnosis.
Disclosure: G Arrambide has received compensation for consulting services from Biogen-Idec, research support from Novartis, and speaking honoraria from Sanofi-Aventis.
M Tintore has received compensation for consulting services and speaking honoraria from Bayer Schering Pharma, Merck-Serono, Biogen-Idec, Teva Pharmaceuticals, Sanofi-Aventis, Novartis, Almirall, Genzyme, and Roche. Ç
C Espejo reports no disclosures.
M Castillo reports no disclosures.
C Auger has received speaking honoraria from Novartis, Biogen and Stendhal.
J Río has received speaking honoraria and personal compensation for participating on Advisory Boards from Almirall, Bayer-Schering Healthcare, Biogen-Idec, Genzyme, Merck-Serono, Novartis, Teva, and Sanofi-Aventis.
J Castilló reports no disclosures.
A Vidal-Jordana has received speaking honoraria and consulting fees from Novartis, Roche, and Sanofi-Aventis.
I Galán reports no disclosures.
C Nos reports no disclosures.
M Comabella has received compensation for consulting services and speaking honoraria from Bayer Schering Pharma, Merk Serono, Biogen-Idec, Teva Pharmaceuticals, Sanofi-Aventis, and Novartis.
R Mitjana reports no disclosures.
P Mulero reports no disclosures.
A de Barros reports no disclosures.
B Rodríguez-Acevedo reports no disclosures.
L Midaglia reports no disclosures.
J Sastre-Garriga has received compensation for participating on Advisory Boards, speaking honoraria and travel expenses for scientific meetings, consulting services or research support from Novartis, Biogen, Serono Symposia International Foundation, Merck, Almirall, and Genzyme.
A Rovira serves on scientific advisory boards for Biogen Idec, Novartis, Genzyme, and OLEA Medical, and on the editorial board of the American Journal of Neuroradiology, Neuroradiology and European Radiology, has received speaker honoraria from Bayer, Genzyme, Sanofi-Aventis, Bracco, Merck-Serono, Teva Pharmaceutical Industries Ltd, OLEA Medical, Stendhal, Novartis and Biogen Idec, and has research agreements with Siemens AG.
X Montalban has received speaking honoraria and travel expenses for participation in scientific meetings, has been a steering committee member of clinical trials or participated in advisory boards of clinical trials in the past with Actelion, Amirall, Bayer, Biogen, Celgene, Genzyme, Hoffmann-La Roche, Novartis, Oryzon Genomics, Sanofi-Genzyme and Teva Pharmaceutical.