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Predictors of relapse in MOG antibody associated disease: a cohort study
Saif Huda1, Daniel Whittam2,3, Richard Jackson4
1Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK shuda@nhs.net.
Objective:
To identify factors predictive of relapse risk and disability in myelin oligodendrocyte glycoprotein associated disease (MOGAD).
Setting:
Patients 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.
Participants:
Patients with MOGAD=76 from England, Northern Ireland and Scotland were included in this cohort study.
Results:
Relapsing 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.
Conclusions:
Male 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.
Insights
Male sex and spinal cord involvement predict a lower relapse risk in myelin oligodendrocyte glycoprotein associated disease (MOGAD). Steroid treatment and MOG-antibody negativity also correlate with a monophasic disease course.
Area of Science:
- Neuroimmunology
- Demyelinating Diseases
- Autoimmune Disorders
Background:
- Myelin oligodendrocyte glycoprotein associated disease (MOGAD) is a rare autoimmune disorder affecting the central nervous system.
- Understanding factors influencing disease course is crucial for patient management.
Purpose of the Study:
- To identify predictors of relapse risk and disability in adult patients with MOGAD.
- To analyze factors associated with monophasic versus relapsing disease courses.
Main Methods:
- A cohort study of 76 adult patients with MOGAD was conducted.
- Statistical analyses, including logistic regression and Cox proportional hazards models, were used to identify predictive factors.
Main Results:
- Relapsing disease occurred in 55% of patients.
- Male sex, transverse myelitis at onset, and prolonged steroid treatment were associated with a monophasic disease course.
- MOG-antibody seroconversion to negative was linked to a reduced relapse risk.
- No factors predicted visual or overall disability.
Conclusions:
- Male sex and spinal cord involvement at onset are associated with a lower risk of relapse and longer time to first relapse in MOGAD.
- Early, prolonged steroid treatment may promote a monophasic course.
- MOG-antibody seroconversion to negative is a significant predictor of lower relapse risk, potentially guiding treatment decisions.
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