Immunopathological Patterns of MS May Predict Response to Apheresis

Response to apheresis treatment may be associated with specific types of histopathologically classified immunopathological patterns in multiple sclerosis (MS), according to a single-center cohort study published in JAMA Neurology.

This study included 69 individuals from Germany with a mean age of 36.6 (standard deviation 13.3) years, each with proven inflammatory demyelination consistent with early MS and least 2 prior treatments with plasma exchange or immunoadsorption for steroid-unresponsive acute MS attacks.

These patients were grouped into patterns 1, 2, and 3 based on analysis of brain biopsies. Patterns 1 and 2 exhibited macrophage- and T-cell-associated demyelination, pattern 2 exhibited immunoglobulin and related deposits, and pattern 3 exhibited oligodendrocyte degeneration.

There were 16 patients (23%) with pattern 1 disease, 40 patients (58%) with pattern 2, and 13 (19%) with pattern 3. All 69 patients were administered apheresis treatments. Functional improvement in relapse related neurological deficit was the primary outcome of this study, with secondary outcomes being Expanded Disability Status Scale and radiological changes.

Although 0 out of 13 patients with pattern 3 lesions showed functional improvement, 5 out of 16 patients (31%) with pattern 1 and 22 out of 40 (55%) with pattern 2 did (pattern 2 vs 3, P <.001). There were radiological improvements in 4 patients (25%) with pattern 1, 22 (56%) with pattern 2, and 1 (11%) with pattern 3.

In terms of the Expanded Disability Status Scale, the respective response rates were 25%, 40%, and 0% in patients with patterns 1, 2, and 3. Brainstem involvement turned out to be negatively predictive for response to functional therapy (logarithmic odds ratio [logOR], 1.43; P =.03), but immunoadsorption showed potential as a positive predictor (logOR, 3.26; P =.01).

Researchers conclude that “the response to apheresis treatment is associated with immunopathological patterns. Patients with both patterns 1 and 2 improved clinically after apheresis treatment, but pattern 2 patients who showed signs of a humoral immune response benefited most. Apheresis appears unlikely to benefit patients with pattern 3 lesions.”

Reference

Stork L, Ellenberger D, Beißbarth T, et al. Differences in the responses to apheresis therapy of patients with 3 histopathologically classified immunopathological patterns of multiple sclerosis [published online February 5, 2018]. JAMA Neurol. doi: 10.1001/jamaneurol.2017.4842