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Early Maintenance Treatment Initiation and Relapse Risk Mitigation After a First Event of MOGAD in Adults: The
Romain Deschamps1, Jessica Guillaume1, Jonathan Ciron1
1From the Department of Neurology (R.D.); Clinical Research Department (J.G.), Rothschild Foundation Hospital, Paris; Department of Neurology (J.C.), University Hospital of Toulouse; Department of Neurology (B.A.), Pôle de Neurosciences Cliniques, APHM, Aix Marseille University, Hôpital de la Timone; Department of Neurology (A.R.), University Hospital of Bordeaux; Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM) (E.M., C.G.), Department of Neurology, AP-HP, Pitié-Salpêtrière Hospital, Paris; Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM) (J.P., L.B., R.M.), Department of Neurology, sclérose en plaques, pathologies de la myéline et neuro-inflammation, Hôpital Neurologique Pierre Wertheimer; Department of Neurology (D.A.L.), CR2TI-Inserm U1064, CIC1314, Nantes Université, University Hospital of Nantes; Department of Neurology (L. Michel), INSERM UMR 1236, Université de Rennes 1, University Hospital of Rennes, Rennes, France; Center for Clinical Investigation (N.C.), INSERM U1434; Biopathology of Myelin, Neuroprotection and Therapeutic Strategy, INSERM U1119; Department of Neurology, University Hospital of Strasbourg; CRC SEP Neurologie Pasteur 2 (M.C.), University Hospital of Nice, Université Cote d'Azur, UMR2CA (URRIS), Nice; CRC SEP (X.A.), CRMR Leukofrance, Department of Neurology, INM / U1298, Gui de Chauliac Hospital, University Hospital of Montpellier; Department of Neurology (E.T.), University Hospital of Nimes; CRC SEP (H.Z.), Department of Neurology, U 1172, University Hospital of Lille; Department of Neurology (B.B.), University Hospital of Rouen; Neuro Ophthalmology Unit (C.F.T.), Hospices Civils de Lyon, Claude Bernard Lyon 1 University, Lyon Neuroscience Research Center CRNL U1028 UMR 5292, IMPACT F-69500, Neurological Hospital of Lyon; Department of Neurology (T.M.), University Hospital of Dijon; Department of Neurology (P.C.), University Hospital of la Rochelle; Department of Neurology (P.K.), Hospital of Luxembourg, Luxembourg-Ville, Luxembourg; Department of Child Neurology and Child Intensive Care Unit (S.C.), Hospital of Pau; Department of Neurology (N. Maubeuge), University Hospital of Poitiers; Department of Neurology (K.H.), Delafontaine Hospital, Saint-Denis; Department of Neurology (C.N.), Andre Mignot hospital, Hospital of Versailles, Le Chesnay; Department of Neurology (E.B.), University Hospital of Besancon; Department of Neurology (H.M.), Sud Francilien Hospital, Corbeil-Essonnes; CRC SEP Limoges/Poitiers (L. Magy), CRMR Maladies Neuromusculaires AOC (FILNEMUS), UR 2018 NeurIT, University Hospital of Limoges; Department of Neurology (F.K.), Meaux Hospital; Department of Neurology (M.S.R.), University Hospital of Bicêtre, Le Kremlin-Bicêtre; Department of Neurology (L.H.), Felix Guyon University Hospital, Saint Denis, Reunion; Department of Neurology (M.G.), Hospital of Valenciennes; Department of Neurology (P.B.), University Hospital of Caen Normandie; CRC SEP (A.M.), Department of Neurology, University Hospital of Tours, Bretonneau Hospital; Department of Neurology (G.M.), Nancy University Hospital; Université de Lorraine, EA 4360 APEMAC, Vandoeuvre-Lès-Nancy; Department of Neurology (M.M.), University Hospital of Reims; Department of Neurology (N. Mélé), Sainte-Anne Hospital, GHU Paris Psychiatrie et Neurosciences, Paris Cité University, INSERM 1266; and Department of Neurology (C.P.), Rothschild Foundation Hospital, Paris, France.
Background And Objectives:
Because myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a recently identified autoimmune disorder, the natural history of MOGAD is still not well described. The objective of this study was to describe the long-term outcomes of adult patients with MOGAD. In addition, we aimed to identify factors affecting relapse risk and neurologic outcomes.
Methods:
Clinical and biological data were obtained from patients with a first event of MOGAD and included in the French nationwide incident cohort between February 2014 and March 2017. Only patients aged 18 years or older at disease onset and with observation period of at least 3 months were included. Data were collected prospectively until July 2023 and registered in the dedicated French nationwide database. This form includes every relapse with phenotype description during follow-up, date of last assessment, final clinical outcome with Expanded Disability Status Scale score and visual acuity, and maintenance therapy. The probability of recurrence-free survival was assessed using the Kaplan-Meier method.
Results:
We included 128 patients. The onset phenotype was isolated optic neuritis in 81 patients (63.3%) and isolated myelitis in 25 patients (19.5%). The median follow-up duration was 77.8 months (range 3.2-111.2), with 49 patients (38.3%) experienced at least one relapse. Median times from onset to second and third attacks were 3.2 (1.0-86.2) and 13.0 (2.6-64.4) months, respectively. At the last assessment, Expanded Disability Status Scale Score was ≥3 and ≥6 in 22 (17.2%) and 6 (4.7%) patients, respectively. Eighty patients received at least one maintenance treatment. This treatment was initiated after the first attack in 47 patients (36.7% of the whole cohort) and at the time of a second attack in 25 (19.5%). Multivariate analysis revealed that initiating maintenance treatment after the first attack was associated with a lower relapse risk (OR = 0.26 [95% CI 0.11-0.62], p = 0.002). In patients receiving maintenance therapy after first attack, the 2-year, 4-year, 6-year, and 8-year relapse risks were 11%, 15%, 20%, and 20%, respectively. In other patients, the risks were 41%, 46%, 51%, and 56%.
Discussion:
The highest risk of a relapse in MOGAD occurs early, and initiating maintenance therapy from the first attack substantially reduced the relapse risk.
Classification Of Evidence:
This study provides Class III evidence that initiating maintenance therapy from the first attack in patients with MOGAD reduces the relapse risk.
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