Highlights
- •Patients with MOG-AD may have a monophasic or relapsing disease course.
- •57% of our cohort had a relapsing course.
- •The most common relapse phenotype was optic neuritis.
- •Neither age, gender, race, initial attack, or antibody titer predicted relapse risk.
- •50% of patients on disease modifying therapy continued to relapse.
Abstract
Background
While many patients with myelin oligodendrocyte glycoprotein antibody-mediated disease
(MOG-AD) will have a monophasic course, 30-80% of patients will relapse after the
initial attack. It is not known which factors predict relapse. Here we describe our
clinical experience with MOG-AD and evaluate for factors that correlate with relapsing
disease.
Methods
This was a retrospective, multi-institutional study of 54 patients with MOG-AD, including
17 children and 37 adults. Mann-Whitney U and Fischer's Exact tests were used for
comparisons and logistic regression for correlations.
Results
Incident attack phenotype included acute disseminated encephalomyelitis (15%), unilateral
optic neuritis (ON; 39%), bilateral ON (24%), transverse myelitis (TM; 11%) and ON
with TM (11%). Pediatric patients were more likely than adults to present with ADEM
(p = .009) and less likely to present with unilateral ON (p = .04). 31 patients (57%) had a relapsing disease course, with time to first relapse
of 8.2 months and median annualized relapse rate of 0.97 months. In 40% of patients
(n = 22) the first relapse occurred following the withdrawal of treatment for the incident
attack. 5 patients converted to seronegative at follow up, 2 of whom later relapsed.
Logistic regression revealed no significant relationship between age, gender, race,
presentation phenotype, antibody titer, or cerebrospinal fluid results with risk of
relapse. For patients who started disease modifying therapy (DMT) prior to the first
relapse (n = 11), 64% remained monophasic. 50% (n = 15) of patients on DMT continued to have disease activity, requiring treatment adjustment.
Conclusions
It is difficult to predict which patients with MOG-AD will relapse. Research is needed
to determine the optimal timing and choice of treatment.
Keywords
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Article info
Publication history
Published online: August 28, 2021
Accepted:
August 26,
2021
Received in revised form:
July 23,
2021
Received:
January 9,
2021
Identification
Copyright
© 2021 Elsevier B.V. All rights reserved.
