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Science News: Anti-MAG Antibodies in 202 Patients: Clinicopathological and Therapeutic Features

Submitted by Francisco E. Gomez, MD, News Science Editorial Board
Edited by Lisa M. Williams, MD, News Science Editorial Board
Svahn, J, Petiot P, Antoine JC et al. Anti-MAG antibodies in 202 patients: clinicopathological and therapeutic features. Journal of Neurology, Neurosurgery & Psychiatry. Oct 2017; pii: jnnp-2017-316715. doi: 10.1136/jnnp-2017-316715
In this study, the authors characterize neuropathy arising from anti-myelin-associated-glycoprotein (anti-MAG) antibodies, as an IgM monoclonal gammopathy in order to assess the pathologic features and clinical management of anti-MAG associated neuropathies. They evaluated 202 patients, 65.8% male, with a mean age of 62.6 years, with emphasis on the typical and atypical phenotypes. Typical neuropathy phenotypes included patients with sensory ataxia and distal polyneuropathy with or without neuropathic tremor and progressive motor deficits in lower limbs. Atypical neuropathy phenotypes included patients with GBS-like manifestations, chronic sensorimotor polyradiculoneuropathies, small fiber neuropathies, or asymmetric/multifocal neuropathy.
Rituximab was the most commonly employed treatment in Anti-MAG neuropathy in this study and it was administered to 45.5% of the study population. Although about 33% of the treated patients responded favorably, another 12% exhibited reversible and fleeting clinical worsening during or after Rituximab. The authors did note an association between earlier treatment during the disease course and stabilization or improvement.
Comments: This study is the largest Anti-MAG cohort evaluated to date, painting a clearer picture of the disease manifestations and management including use of rituximab. MGUS is not an uncommon entity and this study highlights the need to keep anti-MAG workup in mind in certain patients with neuropathies which may portend better outcomes by expediting appropriate treatment. 

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