Myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease: Presentation and outcomes of adults at a single center.

Abstract

Background/introduction

Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a chronic demyelinating disorder that has been increasingly recognized since the serum antibody became commercially available in 2017. The most common clinical presentation is optic neuritis, and first line acute treatment is intravenous (IV) steroids. However, there are many questions that remain unanswered. For clinicians and patients, the primary question is whether relapses will occur and whether to treat with chronic therapy.

Methods

This retrospective chart review examined characteristics of thirty-three known adult MOGAD cases at a single institute. Data was collected on patient demographics, clinical presentation, objective diagnosis with MRI and serum antibody levels, acute and chronic treatment and disease outcomes.

Results

Our MOGAD cases revealed a slight female to male predominance of 1.5:1. No racial groups were affected disproportionately, and age of symptom onset spanned a large range with a median of 40 years. The most common clinical and radiologic presentation was optic neuritis followed by transverse myelitis and brainstem symptoms/lesions. IV methylprednisolone was used in the vast majority of cases for acute treatment. 83.3% of our patients were treated with chronic therapy at some point during their disease course. Therapies include rituximab, IVIG, ocrelizumab, mycophenolate mofetil and ofatumumab. The majority of our patients were treated with rituximab and we did not see a significant benefit of yearly relapse reduction for rituximab versus other therapies. Our cohort had a higher-than- expected percentage of cases with relapsing disease (56.3%) compared to monophasic (43.8%).

Discussion/conclusion

Our study confirms prior data regarding the demographics, clinical presentation and radiologic presentation of MOGAD. There is no consensus on whether maintenance therapy should be started for MOGAD cases with a single clinical event. Our cohort showed a higher relapse rate than has been reported previously and all known relapses occurred within one year of diagnosis. More data is necessary to confirm risk of relapse in the years following diagnosis. In addition, further data on biomarkers are needed to predict the disease course could help guide management.

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Citation

Published Version (Please cite this version)

10.1016/j.jneuroim.2022.577987

Publication Info

Sutton, Paige, Michael W Lutz, F Lee Hartsell, Dorlan Kimbrough, N Troy Tagg, Mark Skeen, Nicholas M Hudak, Christopher Eckstein, et al. (2022). Myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease: Presentation and outcomes of adults at a single center. Journal of neuroimmunology, 373. p. 577987. 10.1016/j.jneuroim.2022.577987 Retrieved from https://hdl.handle.net/10161/26147.

This is constructed from limited available data and may be imprecise. To cite this article, please review & use the official citation provided by the journal.

Scholars@Duke

Lutz

Michael William Lutz

Professor in Neurology

Developing and using computational biology methods to understand the genetic basis of disease with a focus on Alzheimer’s Disease.   Recent work has focused on identification and validation of clinically-relevant biomarkers for Alzheimer’s disease and Alzheimer’s disease with Lewy bodies.

Hartsell

Fletcher Lee Hartsell

Assistant Professor of Neurology

Emerging MS Therapeutics (Immunomodulators as well as symptomatic therapies), Role of Vitamin D in MS Immunopathogenesis, Underlying mechanisms of MS symptoms.

Tagg

Nathan Troy Tagg

Associate Professor in Ophthalmology

N Troy Tagg, MD (Associate Professor in Ophthalmology) joined us from The Uniformed Services
University and Walter Reed National Military Medical Center in Bethesda, MD. He completed his Neuro-
Ophthalmology fellowship in the Department of Ophthalmology and Visual Sciences at The University of
Iowa in Iowa City, IA. Dr. Tagg completed residency training in neurology at Walter Reed Army Medical
Center (Washington, DC) and National Naval Medical Center (Bethesda, MD). He earned his Doctor of
Medicine degree from the University of Iowa Carver College of Medicine. His interests include
autoimmune conditions that affect vision (neuromyelitis optica, multiple sclerosis, myasthenia gravis,
etc.), vascular disorders, and pseudotumor cerebri, among others. He sees patients at the Main Eye
Center in Durham.

Skeen

Mark Brian Skeen

Professor of Neurology
Hudak

Nicholas Mark Hudak

Associate Professor in Family Medicine and Community Health

Nicholas Hudak is an Associate Professor in the Department of Family Medicine and Community Health in the Duke University School of Medicine. He is faculty clinical coordinator with the Duke Physician Assistant (PA) Program, practicing PA in the Department of Neurology, and an Assistant Director in the Duke Center for Interprofessional Education and Care. 

Eckstein

Christopher Paul Eckstein

Associate Professor of Neurology

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