Predictors of a relapsing course in myelin oligodendrocyte glycoprotein antibody-associated disease

BackgroundMyelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a recently described demyelinating disorder, and children represent about 50% of all cases. Almost half of the patients experience relapses, but very few studies have evaluated predictors of relapse risk, challengin...

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Veröffentlicht in:Journal of neurology, neurosurgery and psychiatry Jg. 96; H. 1; S. 68 - 75
Hauptverfasser: Virupakshaiah, Akash, Schoeps, Vinicius A, Race, Jonathan, Waltz, Michael, Sharayah, Siefaddeen, Nasr, Zahra, Moseley, Carson E, Zamvil, Scott S, Gaudioso, Cristina, Schuette, Allison, Casper, Theron Charles, Rose, John, Flanagan, Eoin P, Rodriguez, Moses, Tillema, Jan-Mendelt, Chitnis, Tanuja, Gorman, Mark P, Graves, Jennifer S, Benson, Leslie A, Rensel, Mary, Abrams, Aaron, Krupp, Lauren, Lotze, Timothy E, Aaen, Gregory, Wheeler, Yolanda, Schreiner, Teri, Waldman, Amy, Chong, Janet, Mar, Soe, Waubant, Emmanuelle
Format: Journal Article
Sprache:Englisch
Veröffentlicht: England BMJ Publishing Group Ltd 01.01.2025
BMJ Publishing Group LTD
Schlagworte:
Activities of daily living
Adolescent
Antibodies
Autoantibodies - blood
Autoimmune diseases
Body mass index
Brain research
Child
Child, Preschool
Demyelinating Autoimmune Diseases, CNS - immunology
Disease prevention
Education
Ethnicity
Female
Glycoproteins
Hispanic Americans
Hospitals
Humans
Immunoglobulins
Immunologic Factors - therapeutic use
Immunotherapy
Male
Medical prognosis
Monoclonal antibodies
Multiple sclerosis
Myelin-Oligodendrocyte Glycoprotein - immunology
NEUROIMMUNOLOGY
Pediatrics
Preventive maintenance
Prospective Studies
Recurrence
Risk Factors
Rituximab - therapeutic use
Sex Factors
Steroids
MULTIPLE SCLEROSIS
NEUROIMMUNOLOGY
ISSN:0022-3050, 1468-330X, 1468-330X
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Zusammenfassung:BackgroundMyelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a recently described demyelinating disorder, and children represent about 50% of all cases. Almost half of the patients experience relapses, but very few studies have evaluated predictors of relapse risk, challenging clinical management. The study aimed to identify predictors at MOGAD onset that are associated with a relapsing course.MethodsProspectively collected data from paediatric patients with MOGAD seen by the US Network of Paediatric MS Centres were leveraged. Univariable and adjusted multivariable models were used to predict recurrent disease.ResultsWe identified 326 MOGAD cases (mean age at first event 8.9 years [SD 4.3], 57% female, 77% white and 74% non-Hispanic) and 46% relapsed during a mean follow-up of 3.9 years (SD 4.1). In the adjusted multivariable model, female sex (HR 1.66, 95% CI 1.17 to 2.36, p=0.004) and Hispanic/Latino ethnicity (HR 1.77, 95% CI 1.19 to 2.64, p=0.005) were associated with a higher risk of relapsing MOGAD. Maintenance treatment initiated before a second event with rituximab (HR 0.25, 95% CI 0.07 to 0.92, p=0.037) or intravenous immunoglobulin (IVIG) (HR 0.35, 95% CI 0.14 to 0.88, p=0.026) was associated with lower risk of a second event in multivariable analyses. Conversely, maintenance steroids were associated with a higher estimated relapse risk (HR 1.76, 95% CI 0.90 to 3.45, p=0.097).ConclusionSex and ethnicity are associated with relapsing MOGAD. Use of rituximab or IVIG therapy shortly after onset is associated with a lower risk of the second event. Preventive treatment after a first event could be considered for those with a higher relapse risk.
Bibliographie:Original research
ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
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ISSN:0022-3050
1468-330X
1468-330X
DOI:10.1136/jnnp-2024-333464