Disability and Relapse Risk in Late-Onset Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease

Area of Science:

• Neurology
• Immunology
• Neuroimmunology

Background:

• The impact of late onset in myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) remains controversial.
• Understanding MOGAD onset is crucial for patient management and prognosis.

Purpose of the Study:

• To investigate the association between late onset MOGAD (LO-MOGAD) and moderate disability and relapse in Korean patients.
• To compare outcomes between adult-onset MOGAD (AO-MOGAD) and LO-MOGAD.

Main Methods:

• A nationwide, multicenter, retrospective cohort study included 350 adult MOGAD patients diagnosed using 2023 international criteria.
• Patients were categorized into AO-MOGAD (18-49 years) and LO-MOGAD (≥50 years).
• Primary outcomes included time to first relapse and moderate disability (Expanded Disability Status Scale [EDSS] ≥3).

Main Results:

• Late onset MOGAD (LO-MOGAD) showed less frequent brain involvement but a more frequent monophasic course compared to AO-MOGAD.
• LO-MOGAD was associated with a higher EDSS score at last follow-up.
• Late onset was not significantly associated with relapse risk (aHR, 0.72; P=.11) but was linked to a higher risk of moderate disability (aOR, 2.84; P=.004).

Conclusions:

• Late onset MOGAD is not associated with an increased risk of relapse.
• Late onset MOGAD is associated with a significantly higher risk of moderate disability.
• Prospective studies are warranted to better understand and manage late-onset MOGAD.