Myelin oligodendrocyte glycoprotein (MOG) antibody-mediated disease: The difficulty of predicting relapses
Samantha E Epstein1, Seth Levin1, Kaho Onomichi1
1Columbia Multiple Sclerosis Center & Center for Translational and Computational Neuroimmunology, Department of Neurology, Columbia University Irving Medical Center, 710 West 168th Street, New York, NY, USA 10032.
Background:
While many patients with myelin oligodendrocyte glycoprotein antibody-mediated disease (MOG-AD) will have a monophasic course, 30-80% of patients will relapse after the initial attack. It is not known which factors predict relapse. Here we describe our clinical experience with MOG-AD and evaluate for factors that correlate with relapsing disease.
Methods:
This was a retrospective, multi-institutional study of 54 patients with MOG-AD, including 17 children and 37 adults. Mann-Whitney U and Fischer's Exact tests were used for comparisons and logistic regression for correlations.
Results:
Incident attack phenotype included acute disseminated encephalomyelitis (15%), unilateral optic neuritis (ON; 39%), bilateral ON (24%), transverse myelitis (TM; 11%) and ON with TM (11%). Pediatric patients were more likely than adults to present with ADEM (p = .009) and less likely to present with unilateral ON (p = .04). 31 patients (57%) had a relapsing disease course, with time to first relapse of 8.2 months and median annualized relapse rate of 0.97 months. In 40% of patients (n = 22) the first relapse occurred following the withdrawal of treatment for the incident attack. 5 patients converted to seronegative at follow up, 2 of whom later relapsed. Logistic regression revealed no significant relationship between age, gender, race, presentation phenotype, antibody titer, or cerebrospinal fluid results with risk of relapse. For patients who started disease modifying therapy (DMT) prior to the first relapse (n = 11), 64% remained monophasic. 50% (n = 15) of patients on DMT continued to have disease activity, requiring treatment adjustment.
Conclusions:
It is difficult to predict which patients with MOG-AD will relapse. Research is needed to determine the optimal timing and choice of treatment.
Insights
Predicting relapse in myelin oligodendrocyte glycoprotein antibody-mediated disease (MOG-AD) is challenging, as factors like age or presentation do not reliably indicate future attacks. Further research is needed for optimal MOG-AD treatment strategies.
Area of Science:
- Neurology
- Immunology
- Neuroimmunology
Background:
- Myelin oligodendrocyte glycoprotein antibody-mediated disease (MOG-AD) often presents with a monophasic course, but 30-80% of patients experience relapses.
- Predictive factors for relapse in MOG-AD remain largely unknown.
- This study evaluates clinical experience to identify factors associated with relapsing MOG-AD.
Purpose of the Study:
- To investigate clinical factors correlating with relapsing disease courses in MOG-AD.
- To analyze the impact of initial presentation and demographics on relapse risk.
- To assess the effectiveness of disease-modifying therapies (DMTs) in preventing relapse.
Main Methods:
- Retrospective, multi-institutional study involving 54 patients diagnosed with MOG-AD.
- Statistical analyses included Mann-Whitney U and Fischer's Exact tests for comparisons.
- Logistic regression was employed to identify correlations between various factors and relapse risk.
Main Results:
- 57% of patients experienced a relapsing disease course, with the first relapse occurring a median of 8.2 months post-initial attack.
- No significant correlation was found between age, gender, race, phenotype, antibody titer, or CSF findings and relapse risk.
- Early initiation of DMTs prior to the first relapse was associated with a higher rate of remaining monophasic (64%), though 50% of patients on DMTs still showed disease activity.
Conclusions:
- Predicting relapse in MOG-AD is difficult based on current clinical and laboratory parameters.
- A significant proportion of relapses occurred after treatment withdrawal.
- Optimal timing and selection of treatments for MOG-AD require further investigation.
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