Long-term efficacy of mycophenolate mofetil in myelin oligodendrocyte glycoprotein antibody-associated disorders

Abstract

ObjectiveTo investigate whether the use of mycophenolate mofetil (MMF) could reduce the relapse risk in patients with myelin oligodendrocyte glycoprotein (MOG)-immunoglobulin G (IgG)-associated disorders (MOGADs).MethodsThis prospective observational cohort study included patients with MOGAD at Peking Union Medical College Hospital between January 1, 2017, and April 30, 2019. The patients were divided into 2 groups: those with (MMF+) or without (MMF−) MMF therapy. The primary outcome was relapse at follow-up. We used Cox proportional hazards models to calculate hazard ratios (HRs) for relapse.ResultsSeventy-nine patients were included in our MOG cohort. Fifty (63.3%) were adults at index date, and 47 (59.5%) were women. Fifty-four (68.4%) were in the MMF+ group, and 25 (31.6%) were in the MMF− group. Clinical and demographic factors, MOG-IgG titer, and follow-up time (median, 472.5 days for MMF+, 261.0 days for MMF−) were comparable between the groups. Relapse rates were 7.4% (4/54) in the MMF+ group and 44.0% (11/25) in the MMF− group. Of all potential confounders, only the use of MMF was associated with reduced risk of relapse. The HR for relapse among patients in the MMF+ group was 0.14 (95% CI, 0.05–0.45) and was 0.08 (95% CI, 0.02–0.28) in a model adjusted for age, sex, disease course, and MOG-IgG titer. MMF therapy also remained associated with a reduced relapse risk in sensitivity analyses. Only one patient (1.9%) discontinued MMF therapy because of adverse effect.ConclusionsThese findings provide a clinical evidence that MMF immunosuppression therapy may prevent relapse in patients with MOGAD.Classification of evidenceThis study provides class IV evidence that for patients with MOGAD, MMF reduces relapse risk.

Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease: Current Insights into the Disease Pathophysiology, Diagnosis and Management

“…However, due to the possible devastating side effects of long-term steroid administration, a switch to a steroid-sparing medication might be considered. Patients treated with immunosuppressants such as AZT (adjunctively with oral steroids), MMF and MTX presented better outcome in terms of relapses and disability [ 52 , 72 , 73 , 74 , 75 ]. The efficacy of RTX is not constant.…”

Recent developments in MOG-IgG associated neurological disorders

“…A recent prospective observational study showed an impressive risk reduction of relapse due to treatment with mycophenolate mofetil (MMF). 133 This study included 79 MOG-IgG positive patients presenting with ADEM, optic neuritis, transverse myelitis and/or brainstem syndrome compatible with deymelination who received either MMF or no immune treatment based on consensual decision with the treating physician and were followed for a median of 400 days; additional treatment for the acute phase with steroid tappering was allowed. Multivariate analyses adjusting for potential confounders such as age, sex, previous disease course and initial level of MOG-IgG titre revealed that MMF treatment resulted in a reduced risk of relapse by 86%.…”

“…Multivariate analyses adjusting for potential confounders such as age, sex, previous disease course and initial level of MOG-IgG titre revealed that MMF treatment resulted in a reduced risk of relapse by 86%. 133 …”

N2 year in review

“… 68 , 69 Against this background, a prospective observational cohort study from China, although not a randomized trial, provides valuable clinical evidence on the effect of MMF on relapse rates in MOGAD. 70 Seventy-nine patients with MOGAD (children and adults, 54 on MMF and 25 without MMF; both groups had an additional and comparable steroid taper) were followed over a median of 261 days (without MMF) and 472.5 days (with MMF). Relapse rates were 7.4% in the w/ MMF group and 44% in the w/o MMF group.…”