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Circulating Level of Myelin Basic Protein Predicts Postherpetic Neuralgia

Supplemental Digital Content is available in the text. Objectives: Patients with herpes zoster (HZ) would benefit from accurate prediction of whether they are likely to develop postherpetic neuralgia (PHN). We investigated whether a circulating biomarker of neuronal damage could be a predictor of PHN in this nonmatched prospective, nested, case-control study. Materials and Methods: We included patients with HZ who were within 90 days after rash onset. Volunteers without a history of HZ were recruited as controls. We evaluated epidemiologic factors and circulating neuronal damage biomarkers, including cell-free DNA, myelin basic protein (MBP), and soluble protein-100B (S100B). We conducted logistic regression analyses to develop a prediction model of PHN. Results: We found that cell-free DNA and MBP levels were higher in patients with HZ (n=71) than in controls (n=37). However, only MBP level was higher in patients who developed PHN (n=25), in comparison with those who did not (n=46). MBP level and 3 clinical factors, age, acute pain severity, and response to treatment drugs were identified as independent predictors of PHN. Receiver operating characteristic (ROC) curve analysis showed that the prediction made using a combination of MBP level and clinical factors had an area under ROC curve of 0.853 (95% confidence interval: 0.764 to 0.943), which was better than prediction using clinical factors alone (area under ROC curve: 0.823, 95% confidence interval: 0.728 to 0.917). Discussion: Our results indicate that circulating MBP level in patients with HZ is a predictor for PHN. The combination of clinical predictors and MBP level enhanced the prediction performance.