Can B-Cells Predict Which MS Patients Respond to Treatment?
When someone is diagnosed with relapsing-remitting multiple sclerosis (RRMS), one of the toughest challenges doctors face is deciding on the first treatment. Currently, the choice between disease-modifying therapies (DMTs) like glatiramer acetate (GA) or interferon-β (IFN-β) is still largely trial-and-error. This often means patients cycle through different therapies until one works—a process that can waste valuable time during the early, most treatable stage of the disease.
A study by Tacke and colleagues, published in Neurology: Neuroimmunology & Neuroinflammation in 2021, offers hope for a more personalized approach. The researchers explored whether a blood-based test that measures B-cell activity could predict which patients will respond to GA or IFN-β.
Why Focus on B-Cells?
Multiple sclerosis (MS) is driven by the immune system mistakenly attacking the brain and spinal cord. While T-cells have long been considered the main culprits, evidence now shows B-cells also play a key role, especially in producing antibodies against brain proteins and driving inflammation.
Glatiramer acetate (GA) has effects on both T-cells and B-cells, remodeling B-cell function and shifting them toward more “regulatory” (anti-inflammatory) roles.
Interferon-β (IFN-β) mainly works by calming T-cell–driven inflammation and making it harder for immune cells to cross into the brain—but it doesn’t directly affect B-cells.
So, the team hypothesized that patients with B-cell–driven disease might benefit more from GA, while those without strong B-cell involvement might respond better to IFN-β.
The Study at a Glance
Patients: 207 people with RRMS from the German NeuroTransData registry.
Groups:
73 responded to GA, 35 did not.
62 responded to IFN-β, 37 did not.
Definition of “response”: No relapses in the first 12 months of therapy.
Test used: An ELISPOT assay that detects whether B-cells in the blood produce antibodies against human brain proteins.
Key Findings
The ELISPOT test showed impressive predictive power:
Sensitivity: ~74% (ability to correctly identify responders).
Specificity: ~76% (ability to rule out non-responders).
Diagnostic odds ratio: 8.99 (strong predictive value).
Positive predictive value: High for GA responders (0.89).
In plain terms:
Patients with brain-reactive B-cells were much more likely to do well on GA.
Patients without such B-cell activity tended to respond better to IFN-β.
Even more compelling, these differences in outcomes held up not just for one year but for over five years of follow-up. Patients matched to therapy based on their ELISPOT profile experienced fewer relapses and slower disability progression.
Why This Matters
This study is a step toward personalized medicine in MS. If validated further, the ELISPOT test could:
Help doctors choose the right treatment from the start.
Reduce the frustrating cycle of trial-and-error therapy.
Improve long-term outcomes by getting patients on effective therapy earlier.
It also highlights that MS is not one disease but likely a group of subtypes—some more B-cell driven, others more T-cell driven. Recognizing these subtypes could transform how treatments are selected in the future.
Limitations to Keep in Mind
The study was retrospective and used real-world registry data, which can be less precise than clinical trial data.
Only GA and IFN-β were tested—other modern therapies (like anti-CD20 antibodies) weren’t included.
The ELISPOT assay is labor-intensive and not yet standardized for routine clinical use.
Looking Ahead
The results are promising enough to warrant larger, prospective trials. If confirmed, the ELISPOT test could become part of the diagnostic toolkit for RRMS—helping tailor treatments to the biology of each patient.
As B-cell–targeting drugs (like ocrelizumab) continue to gain ground in MS therapy, tests like this may also be useful for predicting who benefits most from these powerful but riskier treatments.
Takeaway
This research suggests that by simply looking at how a patient’s B-cells react to brain proteins, doctors may one day predict whether GA or IFN-β is the better first-line treatment. While more work is needed before this test can be widely adopted, it represents a meaningful move toward personalized MS care.
Disclaimer: This blog post is based on the provided research article and is intended for informational purposes only. It is not intended to provide medical advice. Please consult with a healthcare professional for any health concerns.
References:
Tacke, S., Braune, S., Rovituso, D. M., Ziemssen, T., Lehmann, P. V., Dikow, H., ... & Kuerten, S. (2021). B-cell activity predicts response to glatiramer acetate and interferon in relapsing-remitting multiple sclerosis. Neurology: Neuroimmunology & Neuroinflammation, 8(3), e980.
