NASHVILLE—Patients with multiple sclerosis (MS) and 10 or more oligoclonal bands (OCBs) in CSF may have significantly more clinical and radiographic relapses and clinical progression during short-term follow-up than those who have fewer OCBs, according to data described at the 2018 CMSC Annual Meeting. OCBs may have greater diagnostic weight in the future, and their quantity may be important to consider during the selection of disease-modifying therapies, said the investigators.
Data Suggest the Predictive Value of OCBs
OCBs in the CSF are a common laboratory abnormality in MS. More than 90% of patients with MS have this finding. Previous research has suggested that OCBs predict the likelihood of progressing from clinically isolated syndrome to clinically definite MS. When observed early in the disease course, OCBs indicate a worse prognosis. Reflecting this emerging research, the latest version of the McDonald Criteria for MS diagnosis has incorporated OCBs.
Yet the predictive value of OCBs has been incompletely explored, said Christopher Perrone, MD, a resident at the University of Pennsylvania in Philadelphia, and colleagues. “While most studies examine the presence or absence of OCBs with regard to prognosis, only a few small studies have investigated correlations between the number of OCBs on single disease metrics,” he added.
OCBs May Predict Need for Assistive Devices
In their retrospective study, Dr. Perrone and colleagues intended to examine relationships between the number of OCBs and markers of clinical and radiographic relapses and progression in two-year follow-up. They screened 1,270 patients receiving MS disease-modifying therapies for OCB testing. Further selection criteria included a diagnosis of relapsing-remitting MS and adherence to a DMT with two years of follow-up clinical visits and imaging. In all, 128 patients met the inclusion criteria.
The study’s primary outcome measures were clinical relapses (defined as the number of steroid prescriptions) and radiographic relapses (defined as the number of new lesions on MRI) at two-year follow-up. Secondary outcome measures were clinical progression (categorized as independent, cane, walker, or wheelchair) and radiographic progression (net changes in third ventricular width, lateral ventricular width, and cortical width). Unpaired, two-tailed t tests were used for comparative analyses.
At two years, the number of clinical relapses was significantly greater in patients with 10 or more OCBs, compared with patients with fewer than 10 OCBs. Similarly, patients with 10 or more OCBs were more likely to have radiographic relapses, with nearly twice the number of new lesions on MRI at two years, compared with patients with fewer than 10 OCBs. Although the investigators found no significant difference between groups at baseline in the use of an assistive device, within-subjects analysis demonstrated that the use of a new assistive device was more common for patients with 10 or more OCBs. While lateral ventricular width increased more in patients with 10 or more OCBs, changes in third ventricular width and cortical width were not significantly different between groups.