Early Treatment of First Acute MOGAD Attack Can Modify Disease Trajectory

Time to treatment of the first myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) attack may be associated with the long-term prognosis and autoimmune status of patients, according to study results published in JAMA Neurology.

Researchers conducted a retrospective, nationwide, multicenter cohort study in 14 hospitals in South Korea between November 2009 and August 2023 to evaluate the associations of time to treat the initial acute MOGAD attack with relapse risk and myelin oligodendrocyte glycoprotein immunoglobulin G (MOG-IgG) serostatus. Adults who either relapsed (ie, experienced a new clinical episode that occurred at least 30 days following the onset of the last acute attack) or were followed up for at least 12 months post-disease onset and had a detailed medical record of their initial attack were classified based on the time to treat the first acute MOGAD attack (early, <5 days; intermediate, 5-14 days; late, >14 days).

Primary outcomes included clinical and treatment factors related to relapsing disease course and/or MOG-IgG seronegative conversion. Cox proportional hazards and binary logistic regression analyses were conducted.

A total of 240 patients (median age at onset, 40.4; women, 52.1%; median disease duration, 3.07 years) were included in the study, of whom 184 (76.7%) received acute-phase treatment and 56 (23.3%) did not. Optic neuritis was the most common manifestation (52.1%) at onset and the majority of patients (97.1%) were seropositive for MOG-IgG.

A total of 110 (45.8%) patients relapsed (median time to relapse, 0.45 years).

Of the 116 patients who had at least 2 serum MOG-IgG tests taken at least 1 year apart, 29 (25%) experienced a conversion to seronegative MOG-IgG.

Compared with the early group, the late group in whom acute treatment for the first MOGAD attack was not given within 2 weeks exhibited a 2.64-fold greater risk for relapse (95% CI, 1.43-4.84; P =.002) and the intermediate group demonstrated a 2.02-fold higher risk for relapse (95% CI, 1.10-3.74; P =.02).

Long-term nonsteroidal immunosuppressant (NSIS) maintenance was also independently associated with a lower risk for relapse (adjusted hazard ratio [aHR], 0.24; 95% CI, 0.14-0.42; P <.001).

In a subgroup without NSIS maintenance, the time to treat of the first MOGAD attack remained associated with a higher risk for relapse. Compared with the early group who were treated within 4 days of onset, the intermediate group had a 2.68-fold higher risk for relapse (95% CI, 1.23-5.85; P =.01) and the late group had a 3.51-fold higher risk for relapse (95% CI, 1.64-7.50; P =.001).

Time to treat of the first MOGAD attack was also associated with MOG-IgG seronegative conversion. The likelihood of seronegative conversion was 7.04-fold greater (95% CI, 1.58-31.41; P =.01) in the early vs late group. NSIS maintenance, however, was not associated with seronegative conversion.

Study limitations include the retrospective design, potential selection bias, and exclusion of pediatric patients.

“These data suggest that timing of acute phase treatment for the first MOGAD attack can be associated with the long-term prognosis and autoimmune status of patients,” the study authors concluded.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.