Multiple sclerosis patients with anti-lipid oligoclonal IgM show early favourable response to immunomodulatory treatment.
OBJECTIVE
Interferon beta and Glatiramer acetate are safe immunomodulatory treatments (IT) for multiple sclerosis (MS), but not always effective. New drugs are available, although they show more side-effects and unknown long-term safety profile. Anti-lipid oligoclonal IgM bands (OCMB) distinguish MS patients with early aggressive course. We prospectively studied if IT are effective in these patients or if they are candidates for more aggressive drugs as first therapeutic option.


METHODS
Seventy-five clinically isolated syndrome patients were studied. OCMB and conversion to MS were assessed. Patients suffering at least two demyelinating events within 3 years were considered eligible to start IT.


RESULTS
Eighteen patients showed OCMB (M+) and 57 lacked them (M-). All M+ patients and only 25 M- patients were treated. The other 32 M- patients suffered less MS attacks than those required to initiate treatment. IT similarly reduced relapse rate in both treated groups (P < 0.0001) and reduced Expanded Disability Status Scale (EDSS) progression in M+ patients, whose EDSS score had significantly increased before treatment. EDSS did not change in M- patients during follow-up, regardless if they were treated or not.


CONCLUSIONS
Oligoclonal IgM bands identify MS patients who are candidates for early immunomodulatory treatment as IT improves their initial aggressive disease course.
García-Barragán
N
N
Departments of Neurology and Immunology, Hospital Ramón y Cajal, Madrid, Spain.
Villar
L M
LM
Espiño
M
M
Sádaba
M C
MC
González-Porqué
P
P
Alvarez-Cermeño
J C
JC
D000328:Adult; D001323:Autoantibodies / Q000097:blood*; D018450:Disease Progression; D005260:Female; D000068717:Glatiramer Acetate; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D000068556:Interferon beta-1a; D000068576:Interferon beta-1b; D016899:Interferon-beta / Q000627:therapeutic use; D008055:Lipids / Q000276:immunology*; D008297:Male; D009103:Multiple Sclerosis / Q000188:drug therapy* / Q000276:immunology*; D009186:Myelin Sheath / Q000276:immunology; D043025:Oligoclonal Bands / Q000378:metabolism*; D010455:Peptides / Q000627:therapeutic use; D012008:Recurrence; D012720:Severity of Illness Index; D016896:Treatment Outcome
D001323:Autoantibodies; D007155:Immunologic Factors; D008055:Lipids; D043025:Oligoclonal Bands; D010455:Peptides; D000068576:Interferon beta-1b; D000068717:Glatiramer Acetate; D016899:Interferon-beta; D000068556:Interferon beta-1a