Lipid-Specific IgM Oligoclonal Bands Can Predict Aggressive Multiple Sclerosis Early

Intrathecal immunoglobulin M synthesis (ITMS), a biomarker for poor prognosis in patients with multiple sclerosis (MS), can predict aggressive MS at disease onset when detected by lipid-specific IgM oligoclonal bands (LS-OCMBs), according to recent research published in Neurology Neuroimmunology & Neuroinflammation.

Researchers aimed to detect the best of 4 methods to identify ITMS in patients with a clinically isolated syndrome(CIS) to predict relapse and disease progression.

“..Availability of a test accurately recognizing patients at high risk of disability at disease onset and therefore who are candidates for these highly effective [disease-modifying therapies]DMTs may tip the balance in favor of prescribing them [DMTs] at an early stage,” wrote Enric Monreal, MD, Department of Neurology, Hospital Universitario Ramón y Cajal, Madrid, Spain, on the importance of defining the most effective method of measuring ITMS.

A total of 193 patients were included in this prospective study. Data was collected from the Hospital Universitario Ramon y Cajal MS center in Madrid between June 1996 and December 2017, with a median follow-up of 12.9 years.

Researchers compared the predictive value of 4 methods, including IgM oligoclonal bands (OCMBs), LS-OCMBs, Reibergram, and IgM index, for assessing ITMS to analyze their ability to detect at-risk patients at disease onset.

Researchers found that LS-OCMB identified patients with CIS at higher risk of second relapse, showing at least 2-fold higher sensitivity and a high specificity for predicting disability milestones. Reibergram was also successful at predicting disability milestones. OCMB was not as successful, though researchers said it could still serve as a valid tool. IgM index was poor at predicting all outcomes.

“For this reason, ITMS, when assessed by LS-OCMB, appears to be a good biomarker to identify patients who would be suitable to receive highly effective DMTs in an early stage,” Dr Monreal et al concluded.

Monreal E, Sainz de la Maza S, Costa-Frossard L, et al. Predicting Aggressive Multiple Sclerosis With Intrathecal IgM Synthesis Among Patients With a Clinically Isolated Syndrome. Neurol Neuroimmunol Neuroinflamm. 2021;8(5):e1047. Published 2021 Jul 22. doi:10.1212/NXI.0000000000001047