Age, time, and treatment determine relapse risk in MOGAD

Based on registry data, researchers found that the disease course of myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is monophasic in 40% and relapsing in 60% of the patients, depending on the follow-up time. Important risk factors for a second attack are younger age, longer disease duration, and no treatment.

The Neuromyelitis Optica Study Group (NEMOS) registry provides valuable real-world data on patients with MOGAD. Dr Vivien Häußler (University Medical Center Hamburg, Germany) and colleagues aimed to characterise clinical MOGAD phenotypes, identify risk factors for disease activity, and evaluate the current treatment strategies as well as the efficiency of the different immunotherapies [1].

The study cohort consisted of 248 patients with MOGAD who have been included in the NEMOS registry since 2016. The mean age at disease onset was 34.6 years and 59.7% were women. The mean follow-up was 7.3 years. Described phenotypes were optic neuritis in 46.8%, transverse myelitis in 24.6%, multiple symptoms in 16.9%, and other phenotypes in 11.3%. There were 138 patients (59%) with a relapsing disease course, while 95 (41%) had a single attack. On average, the relapsing group had a longer disease duration (10.6 vs 3.1 years; P<0.001) and a younger age (31.0 vs 39.9 years; P<0.001). After 160 weeks, half of the patients had relapsed; apart from time, an important risk factor for relapse was treatment: untreated patients had a higher risk of relapse than those who were treated at the time of the attack or before the attack (see Figure).

Figure: Impact of time (left) and treatment (right) on the risk of MOGAD relapse [1]



About half of all the patients (51%) received long-term immunotherapy. Over the last 10 years, the use of MS medication declined in this cohort. Azathioprine and rituximab were the most frequently prescribed therapies, the use of which remained stable; over the last 5 years, the use of tocilizumab has increased. The researchers only found a significant beneficial effect of rituximab plus classic immunosuppression (HR 0.17; 95% CI 0.04–0.82, P=0.028) and of tocilizumab (HR 0.09; 95% CI 0.02–0.49; P=0.005), compared with no treatment.

1. Häußler V, et al. Clinical characteristics and immunotherapy in MOGAD patients: data from the NEMOS registry. O117, ECTRIMS 2024, 18–20 September, Copenhagen, Denmark.

 

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Posted on 18 November 202419 November 2024