Predictors of relapse in MOG antibody associated disease: a cohort study

Abstract

ObjectiveTo identify factors predictive of relapse risk and disability in myelin oligodendrocyte glycoprotein associated disease (MOGAD).SettingPatients were seen by the neuromyelitis optica spectrum disorders (NMOSD) service in Liverpool, UK, a national referral centre for adult patients with MOGAD, NMOSD and related conditions.ParticipantsPatients with MOGAD=76 from England, Northern Ireland and Scotland were included in this cohort study.ResultsRelapsing disease was observed in 55% (42/76) of cases. Steroid treatment >1 month (OR 0.2, 95% CI 0.05 to 0.80; p=0.022), transverse myelitis (TM) at first attack (OR 0.03, 95% CI 0.004 to 0.23; p=0.001) and male sex (OR 0.16, 95% CI 0.04 to 0.68; p=0.014) were associated with monophasic disease (area under the curve=0.85). Male sex (HR 0.46, 95% CI 0.24 to 0.89; p=0.011) and TM at disease onset (HR 0.42, 95% CI 0.22 to 0.82; p=0.011) were also associated with an increased latency to first relapse. 45% (32/71) of patients became MOG-antibody negative and in relapsing patients negative seroconversion was associated with a lower relapse risk (relative risk 0.11 95% CI 0.05 to 0.26; p<0.001). No specific factors were predictive of visual or overall disability.ConclusionsMale patients with spinal cord involvement at disease onset have a lower risk of relapsing disease and longer latency to first relapse. Steroid treatment for at least 1 month at first attack was also associated with a monophasic disease course. MOG-antibody negative seroconversion was associated with a lower risk of relapse and may help inform treatment decisions and duration.

Efficacy and safety of rituximab in myelin oligodendrocyte glycoprotein antibody-associated disorders compared with neuromyelitis optica spectrum disorder: a systematic review and meta-analysis

“…First, we identified significant publication bias towards favourable outcomes after RTX therapy; however, whether or not this observation is driven by true unequivocal efficacy cannot be determined without randomised-control trials. Second, the population reported here might be not representative of patients with MOGAD in terms of proportion of relapsing patients (75% against less than 50% in the literature) 8 74 75. Third, a short follow-up after RTX is reported in a consistent number of studies analysed (8/32, 25%), although the meta-regression found no significant association between follow-up duration and effect size.…”

Early Immunotherapy and Longer Corticosteroid Treatment Are Associated With Lower Risk of Relapsing Disease Course in Pediatric MOGAD

“…6,7,11,[14][15][16][17] The persistence of positive MOG antibodies at follow-up has been repeatedly, although not invariably, reported to be associated with higher risk of a relapsing disease course. 2,4,8,11,[14][15][16][18][19][20][21][22] However, current data do not allow a proper prediction of disease course or final outcome at MOGAD onset. 6,17,20,21,[23][24][25][26] In this Italian multicenter cohort of pediatric MOGAD, we strove to identify early clinical-paraclinical factors at disease onset associated with subsequent relapse and final outcome, with particular focus on modifiable factors such as treatment.…”

“…Factors at first event independently associated with lower risk of relapsing disease course were immunotherapy <7 days from onset (6.7-fold reduced odds of relapsing course, OR 0.15, 95% CI 0.03-0.61, p = 0.009), corticosteroid treatment for ≥5 weeks (6.7-fold reduced odds of relapse, OR 0.15, 95% CI 0.03-0.80, p = 0.026), and abnormal optic nerves on onset MRI (12.5-fold reduced odds of relapse, OR 0.08, 95% CI 0.01-0.50, p = 0.007). 21.1% (15/71) had EDSS ≥ 1 at final follow-up. Patients with a relapsing course had a higher proportion of final EDSS ≥ 1 (37.5%, 9/24) than children with monophasic disease (12.8%, 5/39) (p = 0.022, univariate analysis).…”

“… 2 , 4 , 8 , 11 , 14 - 16 , 18 - 22 However, current data do not allow a proper prediction of disease course or final outcome at MOGAD onset. 6 , 17 , 20 , 21 , 23 - 26 …”

MOGAD Involving Cranial Neuropathies: A Case Report and Review of Literature

“…Male patients with myelitis experienced a lower relapse risk. Other predictors include prolonged steroid treatment and the MOG-antibody negative seroconversion [ 13 ]. Among the seven MOG-IgG–positive patients with cranial neuropathies in this review, two had a relapsing disease course both with ON, and the other five remained monophasic.…”