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Organotypic Slice Cultures to Study Oligodendrocyte Dynamics and Myelination
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Disability and Relapse Risk in Late-Onset Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease

Hyunjin Ju1,2, Ki Hoon Kim3,4, Sook Young Woo5

  • 1Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.

JAMA Network Open
|February 13, 2026
PubMed
Abstract

Insights

Late onset myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) did not increase relapse risk but was linked to higher moderate disability. Further research is needed for optimal management of late-onset MOGAD.

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.

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