Therapeutic options and management of polyneuropathy associated with anti-MAG antibodies.
IgM monoclonal gammopathy with anti-MAG (myelin associated glycoprotein) antibodies is associated with demyelinating polyneuropathy. MAG mediates adhesion between the Schwann cell membrane (non-compact myelin) and axons. Various drugs have been tried in this form of neuropathy, with varying responses, but to date there is no consensus on the treatment of this disease.



Based on the medical literature and the experience of our group of clinicians, we offer some proposals for the management of anti-MAG neuropathy. Expert commentary: It is not certain that anti-MAG antibodies are the only factor responsible for symptoms of this clinically heterogeneous neuropathy. Some patients with mild non-evolving symptoms do not require treatment; for more severe cases, treatment should be prompt: intravenous immunoglobulins (or sometimes therapeutic plasma exchange) as first line treatment, then immunosuppressant in refractory forms (such as rituximab).
a Department and Laboratory of Neurology, Centre de Référence 'neuropathies périphériques rares' , University Hospital Limoges , Limoges , France.
Jean-Michel
JM
Vallat
a Department and Laboratory of Neurology, Centre de Référence 'neuropathies périphériques rares' , University Hospital Limoges , Limoges , France.
Laurent
L
Magy
b Department of Neurology, CHU Poitiers , University of Poitiers , Poitiers , France.
Jonathan
J
Ciron
c Department of Neurology , CHU Tours , Tours cedex 9 , France.
Philippe
P
Corcia
d Department of Neurology, Neuro-Muscular Unit , CHU Bordeaux, groupe hospitalier Pellegrin , Bordeaux cedex , France.
Gwendal
G
Le Masson
c Department of Neurology , CHU Tours , Tours cedex 9 , France.
Stéphane
S
Mathis
D001323:Autoantibodies; D003711:Demyelinating Diseases / Q000276:immunology; D006801:Humans; D007075:Immunoglobulin M / Q000276:immunology; D018992:Myelin-Associated Glycoprotein / Q000276:immunology; D011115:Polyneuropathies / Q000276:immunology / Q000628:therapy*
D001323:Autoantibodies; D007075:Immunoglobulin M; D018992:Myelin-Associated Glycoprotein
Anti-MAG; IVIg; demyelinating; intravenous immunoglobulins; neuropathy; rituximab; therapeutic plasma exchange