Early Maintenance Treatment Initiation and Relapse Risk Mitigation After a First Event of MOGAD in Adults
Romain Deschamps, Jessica Guillaume, Jonathan Ciron, Bertrand Audoin, Aurélie Ruet, Élisabeth Maillart, Julie Pique, Lakhdar Benyahya, David Laplaud, Laure Michel, Nicolas Collongues, Mikaël Cohen, Xavier Ayrignac, Éric Thouvenot, Hélène Zéphir, Bertrand Bourre, Caroline Tilikete, Thibault Moreau, Paul Cantagrel, Philippe Kerschen, Sébastien Cabasson, Nicolas Maubeuge, Karolina Hankiewicz, Chantal Nifle, Eric Berger, Hana Megherbi, Laurent Magy, Frédéric Klapczynski, Mariana Sarov Riviere, C. Giannesini, Lorraine Hamelin, Marianne Giroux, Pierre Branger, Aude Maurousset, Guillaume Mathey, Maximilien Moulin, Nicolas Mêlé, Caroline Papeix, Romain Marignier, as the NOMADMUS study group
Abstract
BACKGROUND AND OBJECTIVES: Because myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a recently identified autoimmune disorder, the natural history of MOGAD is still not well described. The objective of this study was to describe the long-term outcomes of adult patients with MOGAD. In addition, we aimed to identify factors affecting relapse risk and neurologic outcomes. METHODS: Clinical and biological data were obtained from patients with a first event of MOGAD and included in the French nationwide incident cohort between February 2014 and March 2017. Only patients aged 18 years or older at disease onset and with observation period of at least 3 months were included. Data were collected prospectively until July 2023 and registered in the dedicated French nationwide database. This form includes every relapse with phenotype description during follow-up, date of last assessment, final clinical outcome with Expanded Disability Status Scale score and visual acuity, and maintenance therapy. The probability of recurrence-free survival was assessed using the Kaplan-Meier method. RESULTS: = 0.002). In patients receiving maintenance therapy after first attack, the 2-year, 4-year, 6-year, and 8-year relapse risks were 11%, 15%, 20%, and 20%, respectively. In other patients, the risks were 41%, 46%, 51%, and 56%. DISCUSSION: The highest risk of a relapse in MOGAD occurs early, and initiating maintenance therapy from the first attack substantially reduced the relapse risk. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that initiating maintenance therapy from the first attack in patients with MOGAD reduces the relapse risk.