Journal Article

Predictors of relapse in MOG antibody associated disease: a cohort study

Hunt, David, Jackson, Richard, Karthikeayan, Venkatraman, Woodhall, Mark, Waters, Patrick, Murray, Katy, Mutch, Kerry, Jacob, Anu, Huda, Saif, Whittam, Daniel, Kneen, Rachel, Linaker, Sam, Kelly, Patricia

2021

Overview

ObjectiveTo identify factors predictive of relapse risk and disability in myelin oligodendrocyte glycoprotein associated disease (MOGAD).SettingPatients 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.ParticipantsPatients with MOGAD=76 from England, Northern Ireland and Scotland were included in this cohort study.ResultsRelapsing 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.ConclusionsMale 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.

• Publisher: British Medical Journal Publishing Group,BMJ Publishing Group LTD,BMJ Publishing Group
• Subject: adult neurology / Age / Antibodies / Aquaporin 4 / Autoantibodies / Cohort analysis / Cohort Studies / Demyelinating Autoimmune Diseases, CNS - epidemiology / England / Female / Glycoproteins / Humans / immunology / Inflammatory diseases / Male / Medical prognosis / Myelin-Oligodendrocyte Glycoprotein / neuro-ophthalmology / Neurology / Northern Ireland / Patients / Recurrence / Scotland / Steroids