From the Guidelines
Having antibodies related to Multiple Sclerosis (MS) implies a distinct disease entity, MOG-IgG-associated encephalomyelitis (MOG-EM), which requires different treatment approaches than MS.
Key Implications
- MOG-EM is characterized by a relapsing course, with a high risk of flare-ups after cessation of steroid treatment, and may require close monitoring and careful steroid tapering 1
- Patients with MOG-EM may be responsive to antibody-depleting treatments, B cell-targeted therapies, and immunosuppressive treatments, but not to certain MS-approved drugs 1
- MOG-IgG testing should be based on specific criteria, such as acute optic neuritis, myelitis, or brainstem encephalitis, and not performed as unselected screening for all patients with suspected or established MS 1
Diagnostic Considerations
- MOG-IgG testing should be considered in patients with acute CNS demyelination, particularly those with longitudinally extensive spinal cord lesions or optic nerve lesions 1
- A positive MOG-IgG test result should be challenged if the patient has a chronic progressive disease course, lesions adjacent to a lateral ventricle, or other atypical features for MOG-EM 1
Treatment Approaches
- Treatment for MOG-EM may involve plasma exchange, immunoadsorption, rituximab, intravenous immunoglobulins, or immunosuppressive treatments, depending on the patient's response and disease course 1
- Close monitoring of the patient's MOG-IgG serostatus is recommended to confirm seronegativity in the long-term course and adjust treatment accordingly 1
From the Research
Implications of Antibodies in Multiple Sclerosis
The presence of antibodies in Multiple Sclerosis (MS) has been associated with various implications, including:
- Disease pathogenesis: Antibodies may play a role in the development and progression of MS, with some studies suggesting that they can mediate damage to myelin membranes 2, 3.
- Diagnostic markers: Oligoclonal bands (OCBs) in the cerebrospinal fluid (CSF) are a common abnormality in MS patients and can be used as a diagnostic marker 3.
- Therapeutic targets: Monoclonal antibodies have been developed as targeted therapies for MS, with several available for treatment and others being tested 4, 5.
- Potential risks: The use of monoclonal antibodies in MS treatment carries the risk of immune reactions, infections, and other autoimmune diseases 4, 5.
Antibody Responses in MS
Antibody responses in MS are complex and involve various cell types, including B cells and plasma cells. Studies have shown that:
- B cells and plasma cells are present in active central nervous system (CNS) lesions in MS patients 2.
- OCBs in the CSF are a hallmark of MS, but their antigenic target(s) remain unknown 3.
- Autoantibodies against specific myelin antigens may mediate damage to myelin membranes 3.
- Natural autoantibodies may enhance remyelination 3.
Monoclonal Antibodies in MS Treatment
Monoclonal antibodies have become a mainstay in the treatment of relapsing MS, with several available options, including:
- Natalizumab, an α4β1 integrin antagonist 4.
- Alemtuzumab, an anti-CD52 monoclonal antibody 4.
- Anti-CD20 monoclonal antibodies, such as rituximab, ocrelizumab, ofatumumab, and ublituximab 4. These therapies have shown efficacy in reducing disease activity and slowing disease progression, but also carry potential risks, such as infections and autoimmune diseases 4, 5.