Highlights
- •Distinguishing MOG antibody disease (MOGAD) from MS and NMO can be difficult.
- •Optic neuritis in MOGAD patients was more frequent and severe compared to MS.
- •Optic neuritis in MOGAD was often relapsing and/or bilateral.
- •MOGAD attacks had a similar nadir but better recovery than NMO attacks.
- •MOGAD was also defined by its characteristically modest CSF abnormalities.
Abstract
Background
Antibodies to myelin oligodendrocyte glycoprotein (MOG) are associated with a CNS
inflammatory disorder distinct from multiple sclerosis (MS) and aquaporin-4 antibody-positive
neuromyelitis optica (NMO). Knowledge of the clinical spectrum of MOG antibody disease
(MOGAD) remains incomplete, particularly in comparison to two related inflammatory
demyelinating diseases, MS and NMO.
Objective
Compare demographics, clinical characteristics, estimated disability, laboratory results,
and treatment responses of a U.S. MOGAD cohort with age- and sex-matched MS and NMO
patients.
Design, setting, and participants
This observational, case-control, single-center study identified each group via ICD-10
diagnosis code searches through the electronic medical records of adult patients seen
at the John L. Trotter MS Center between January 1, 2019 and January 1, 2020. MOGAD
and NMO patients were confirmed to have at least one positive antibody test; those
in the MS group had a confirmed diagnosis by a physician with MS subspecialty training.
Data were collected after IRB approval.
Results
Twenty-six patients were included in each group. MOGAD patients were predominantly
Caucasian (88.5%) with mean onset age of 43.9 years. MOGAD patients had no comorbid
other autoimmune diseases and comparatively lower rates of family members with autoimmune
disease (20.0%) than either MS (40.0%) or NMO (34.6%) matched cohorts. 91% of MOGAD
attacks were monofocal, and over 70% presented with optic neuritis. Severity of MOGAD
attacks was similar to that of seropositive NMO, but the robust degree of recovery
was more similar to MS. Four MOGAD patients converted to negative antibody status,
with no attacks occurring after conversion. Serum ANA and ENA were less frequently
elevated in MOGAD (21.7%, 5.0%) than in seropositive NMO patients (66.7%, 42.9%).
Elevated IgG synthesis rate and positive CSF-restricted oligoclonal bands were not
seen in our MOGAD cohort, and only one MOGAD patient had an elevated IgG index. Despite
anti-CD20 therapy, 28.6% of MOGAD patients continued to suffer relapses.
Conclusions
MOGAD was characterized by a predominantly monofocal presentation (typically optic
neuritis) and severe attacks with better recovery than seen with seropositive NMO
attacks. Lack of CSF-restricted oligoclonal bands distinguished MOGAD from MS.
Keywords
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Article info
Publication history
Published online: July 14, 2020
Accepted:
July 13,
2020
Received in revised form:
July 3,
2020
Received:
May 6,
2020
Identification
Copyright
© 2020 Elsevier B.V. All rights reserved.
