Antibodies to myelin don't predict progression to multiple sclerosis

doi:10.1136/bmj.334.7587.231-a

BMJ 2007;334:231 (3 February), doi:10.1136/bmj.334.7587.231-a

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Antibodies to myelin don't predict progression to multiple sclerosis

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It's hard to predict what will happen to patientswho present with a first neurological episode suggestive ofmultiple sclerosis. Some will recover, whereas others will progressto the full blown clinical disease. An accurate prognostic testwould be a real benefit to patients, and antimyelin antibodieslooked like a good candidate because antibody mediated demyelinationis thought to have a role in this disease. The latest researchhas been disappointing, however. The presence or absence oftwo antimyelin antibodies failed to predict outcome for 462patients taking part in a trial of interferon beta-1b

All participants had experienced just one neurologicalepisode. They also had clinically silent but suggestive changeson magnetic resonance imaging of the brain. No significant associationswere found between the presence of the two antibodies (antibodiesto myelin oligodendrocyte glycoprotein (MOG) and myelin basedprotein (MBP)) and patients' progress over two years. Just undera third of patients developed clinically definite multiple sclerosis,regardless of their antibody status at baseline. The authorsfound no link between the antibodies and progression in anysubgroup of patients, including those given steroids or thoserandomised to the active or control arms of the interferon trial.These antibodies are unlikely to provide useful diagnostic testsfor patients with early disease, say the authors.