Contributions
Abstract: EP1580
Type: Poster Sessions
Abstract Category: Pathology and pathogenesis of MS - Biomarkers
Introduction: On the basis of the 2018 Diagnostic Criteria for Multiple Sclerosis (MS) cerebrospinal fluid-restricted Oligoclonal IgG Bands (IgGOBs) can be used as markers of dissemination in time (DIT) of inflammation. However, DIT criterion can be acquired on the basis of MRI findings and, thus, MS diagnosis can be achieved in the absence of IgGOB.
Objective: To evaluate whether the absence of IgGOB might mark a less aggressive disease course, independently of the number and site of lesions supporting the dissemination in space (DIS) criterion.
Methods: All patients who underwent CSF examination for diagnostic purposes (T0) between January 2016 and April 2016 at the MS Centre in Padua, were retrospectively analysed and included in this study if the following criteria were respected: i) clinically isolated syndrome suggestive of MS; ii) disease duration ≤3 months; iii) MS diagnosis in agreement with the 2017 McDonald criteria; iv) at least 24 months of clinical and radiological follow-up. Brain and spinal cord MRI were acquired at baseline and annually (12 months=T1, 24 months=T2), while clinical evaluations were performed biannually. Clinical relapses and appearance of new/enlarging T2 lesions defined disease activity.
Results: 70 patients completed the 2-year follow-up. IgGOB were detected in 46/70 (66%) patients while 34/70 (48.5%) had gadolinium enhancing lesions. Survival analysis revealed a mild effect of IgGOB (p< 0.05) in predicting disease activity in the overall cohort. When only MS patients with no IgGOB were considered, survival analysis revealed an association with the number of typical site involved (p< 0.05). Indeed, patients with less than 3 typical sites involved had less frequently disease reactivation in the following 24 months (0% vs 50%, p=0.009). Finally, while Kaplan-Mayer analysis revealed a higher probability of disease activity in presence of brainstem (p=0.03) or spinal cord lesions (p< 0.001) at baseline, Cox analysis confirmed only the latter association (O.R. 26.6, IC95% 2.7-257.0, p=0.005). None of these associations was observed in MS patients with IgGOB.
Conclusion: Our findings indicate that the diagnosis of MS in the absence of CSF IgGOB requires a careful evaluation of brain and spinal cord MRI. Moreover, the simultaneous absence of IgGOB and spinal cord lesions identifies patients with a less aggressive disease course.
Disclosure: Puthenparampil Marco received travel grant from Novartis, Almirall, Genzyme, Biogen Idec, Teva and Sanofi Aventis; he has been consultant for Genzyme and Biogen Idec. Martina Saiani and Marta Pengo received travel grants from Teva, Novartis and Genzyme-Sanofi. Miante Silvia reports grants from Novartis, grants from Genzyme Sanofi, grants from Biogen Italia, grants from Almirall, grants from Teva, grants from Merck Serono, outside the submitted work. Rinaldi Francesca serves as an advisory board member of Biogen-Idec and has received funding for travel and speaker honoraria from Merck Serono, Biogen Idec, Sanofi-Aventis, Teva and Bayer Schering Pharma. Perini Paola has received funding for travel and speaker honoraria from Merck Serono, Biogen Idec, Sanofi-Aventis, and Bayer Schering Pharma and has been consultant for Merck Serono, Biogen Idec and Teva. Gallo Paolo has been a consultant for Bayer Schering, Biogen Idec, Genzyme, Merck Serono and Novartis; has received funding for travel and speaker honoraria from Merck-Serono, Biogen Idec, Sanofi-Aventis, Novartis Pharma and Bayer-Schering Pharma, Teva; has received research support from Bayer, Biogen Idec/Elan, MerkSerono, Genzyme and Teva; and has received research grant from the University of Padova, Veneto Region of Italy, the Italian Association for Multiple Sclerosis, the Italian Ministry of Public Health.
Abstract: EP1580
Type: Poster Sessions
Abstract Category: Pathology and pathogenesis of MS - Biomarkers
Introduction: On the basis of the 2018 Diagnostic Criteria for Multiple Sclerosis (MS) cerebrospinal fluid-restricted Oligoclonal IgG Bands (IgGOBs) can be used as markers of dissemination in time (DIT) of inflammation. However, DIT criterion can be acquired on the basis of MRI findings and, thus, MS diagnosis can be achieved in the absence of IgGOB.
Objective: To evaluate whether the absence of IgGOB might mark a less aggressive disease course, independently of the number and site of lesions supporting the dissemination in space (DIS) criterion.
Methods: All patients who underwent CSF examination for diagnostic purposes (T0) between January 2016 and April 2016 at the MS Centre in Padua, were retrospectively analysed and included in this study if the following criteria were respected: i) clinically isolated syndrome suggestive of MS; ii) disease duration ≤3 months; iii) MS diagnosis in agreement with the 2017 McDonald criteria; iv) at least 24 months of clinical and radiological follow-up. Brain and spinal cord MRI were acquired at baseline and annually (12 months=T1, 24 months=T2), while clinical evaluations were performed biannually. Clinical relapses and appearance of new/enlarging T2 lesions defined disease activity.
Results: 70 patients completed the 2-year follow-up. IgGOB were detected in 46/70 (66%) patients while 34/70 (48.5%) had gadolinium enhancing lesions. Survival analysis revealed a mild effect of IgGOB (p< 0.05) in predicting disease activity in the overall cohort. When only MS patients with no IgGOB were considered, survival analysis revealed an association with the number of typical site involved (p< 0.05). Indeed, patients with less than 3 typical sites involved had less frequently disease reactivation in the following 24 months (0% vs 50%, p=0.009). Finally, while Kaplan-Mayer analysis revealed a higher probability of disease activity in presence of brainstem (p=0.03) or spinal cord lesions (p< 0.001) at baseline, Cox analysis confirmed only the latter association (O.R. 26.6, IC95% 2.7-257.0, p=0.005). None of these associations was observed in MS patients with IgGOB.
Conclusion: Our findings indicate that the diagnosis of MS in the absence of CSF IgGOB requires a careful evaluation of brain and spinal cord MRI. Moreover, the simultaneous absence of IgGOB and spinal cord lesions identifies patients with a less aggressive disease course.
Disclosure: Puthenparampil Marco received travel grant from Novartis, Almirall, Genzyme, Biogen Idec, Teva and Sanofi Aventis; he has been consultant for Genzyme and Biogen Idec. Martina Saiani and Marta Pengo received travel grants from Teva, Novartis and Genzyme-Sanofi. Miante Silvia reports grants from Novartis, grants from Genzyme Sanofi, grants from Biogen Italia, grants from Almirall, grants from Teva, grants from Merck Serono, outside the submitted work. Rinaldi Francesca serves as an advisory board member of Biogen-Idec and has received funding for travel and speaker honoraria from Merck Serono, Biogen Idec, Sanofi-Aventis, Teva and Bayer Schering Pharma. Perini Paola has received funding for travel and speaker honoraria from Merck Serono, Biogen Idec, Sanofi-Aventis, and Bayer Schering Pharma and has been consultant for Merck Serono, Biogen Idec and Teva. Gallo Paolo has been a consultant for Bayer Schering, Biogen Idec, Genzyme, Merck Serono and Novartis; has received funding for travel and speaker honoraria from Merck-Serono, Biogen Idec, Sanofi-Aventis, Novartis Pharma and Bayer-Schering Pharma, Teva; has received research support from Bayer, Biogen Idec/Elan, MerkSerono, Genzyme and Teva; and has received research grant from the University of Padova, Veneto Region of Italy, the Italian Association for Multiple Sclerosis, the Italian Ministry of Public Health.