Show simple item record

dc.contributor.authorSatukijchai, C
dc.contributor.authorMariano, R
dc.contributor.authorMessina, S
dc.contributor.authorSa, M
dc.contributor.authorWoodhall, MR
dc.contributor.authorRobertson, NP
dc.contributor.authorMing, L
dc.contributor.authorWassmer, E
dc.contributor.authorKneen, R
dc.contributor.authorHuda, S
dc.contributor.authorJacob, A
dc.contributor.authorBlain, C
dc.contributor.authorHalfpenny, C
dc.contributor.authorHemingway, C
dc.contributor.authorO'Sullivan, E
dc.contributor.authorHobart, J
dc.contributor.authorFisniku, LK
dc.contributor.authorMartin, R
dc.contributor.authorDopson, R
dc.contributor.authorCooper, SA
dc.contributor.authorWilliams, V
dc.contributor.authorWaters, PJ
dc.contributor.authorRamdas, S
dc.contributor.authorLeite, MI
dc.contributor.authorPalace, J

IMPORTANCE: Longer-term outcomes and risk factors associated with myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) are not well established. OBJECTIVE: To investigate longer-term risk of relapse and factors associated with this risk among patients with MOGAD. DESIGN, SETTING, AND PARTICIPANTS: This large, single-nation, prospective cohort study was conducted among 276 patients with MOGAD at 5 health care centers in the UK. Data from January 1973 to March 2020 were collected from 146 patients at Oxford and its outreach sites, 65 patients at Liverpool, 32 patients at a children's hospital in Birmingham, 22 patients at a children's hospital in London, and 11 patients at Cardiff, Wales. Data were analyzed from April through July 2020. MAIN OUTCOMES AND MEASURES: Risk of relapse and annualized relapse rate were evaluated according to different baseline features, including onset age, onset phenotype, and incident vs nonincident group, with the incident group defined as patients diagnosed with antibodies against myelin oligodendrocyte glycoprotein before a second attack. Time to next relapse among patients experiencing relapse was measured and compared between the maintenance therapy subgroup and each first-line treatment group. The no-treatment group was defined as the off-treatment phase among patients who were relapsing, which could occur between any attack or between the last attack and last follow-up. RESULTS: Among 276 patients with MOGAD, 183 patients were identified as being part of the incident group. There were no differences in mean (SD) onset age between total and incident groups (26.4 [17.6] years vs 28.2 [18.1] years), and female patients were predominant in both groups (166 [60.1%] female patients vs 106 [57.9%] female patients). The most common presentation overall was optic neuritis (ON) (119 patients among 275 patients with presentation data [43.3%]), while acute disseminated encephalomyelitis (ADEM), brain, or brainstem onset was predominant among 69 patients aged younger than 12 years (47 patients [68.1%]), including 41 patients with ADEM (59.4%). In the incident group, the 8-year risk of relapse was 36.3% (95% CI, 27.1%-47.5%). ON at onset was associated with increased risk of relapse compared with transverse myelitis at onset (hazard ratio [HR], 2.66; 95% CI, 1.01-6.98; P = .047), but there was no statistically significant difference with adjustment for a follow-on course of corticosteroids. Any TM at onset (ie, alone or in combination with other presentations [ie, ON or ADEM, brain, or brain stem]) was associated with decreased risk of relapse compared with no TM (HR, 0.41; 95% CI, 0.20-0.88; P = .01). Young adult age (ie, ages >18-40 years) was associated with increased risk of relapse compared with older adult age (ie, ages >40 years) (HR, 2.71; 95% CI, 1.18-6.19; P = .02). First-line maintenance therapy was associated with decreased risk of relapse when adjusted for covariates (prednisolone: HR, 0.33; 95% CI, 0.12-0.92; P = .03; prednisolone, nonsteroidal immunosuppressant, or combined: HR, 0.51; 95% CI, 0.28-0.92; P = .03) compared with the no-treatment group. CONCLUSIONS AND RELEVANCE: The findings of this cohort study suggest that onset age and onset phenotype should be considered when assessing subsequent relapse risk and that among patients experiencing relapse, prednisolone, first-line immunosuppression, or a combination of those treatments may be associated with decreased risk of future relapse by approximately 2-fold. These results may contribute to individualized treatment decisions.

dc.publisherAmerican Medical Association (AMA)
dc.subjectAge of Onset
dc.subjectChild, Preschool
dc.subjectDemyelinating Autoimmune Diseases, CNS
dc.subjectMiddle Aged
dc.subjectMyelin-Oligodendrocyte Glycoprotein
dc.subjectProspective Studies
dc.subjectUnited Kingdom
dc.subjectYoung Adult
dc.titleFactors Associated With Relapse and Treatment of Myelin Oligodendrocyte Glycoprotein Antibody–Associated Disease in the United Kingdom
dc.typeJournal Article
plymouth.publication-statusPublished online
plymouth.journalJAMA Network Open
plymouth.organisational-group/Plymouth/Faculty of Health
plymouth.organisational-group/Plymouth/Faculty of Health/Peninsula Medical School
plymouth.organisational-group/Plymouth/REF 2021 Researchers by UoA
plymouth.organisational-group/Plymouth/REF 2021 Researchers by UoA/UoA03 Allied Health Professions, Dentistry, Nursing and Pharmacy
plymouth.organisational-group/Plymouth/Research Groups
plymouth.organisational-group/Plymouth/Research Groups/Institute of Translational and Stratified Medicine (ITSMED)
plymouth.organisational-group/Plymouth/Research Groups/Institute of Translational and Stratified Medicine (ITSMED)/CCT&PS
plymouth.organisational-group/Plymouth/Users by role
plymouth.organisational-group/Plymouth/Users by role/Academics
dc.publisher.placeUnited States
dc.rights.embargoperiodNot known
rioxxterms.typeJournal Article/Review

Files in this item


This item appears in the following Collection(s)

Show simple item record

All items in PEARL are protected by copyright law.
Author manuscripts deposited to comply with open access mandates are made available in accordance with publisher policies. Please cite only the published version using the details provided on the item record or document. In the absence of an open licence (e.g. Creative Commons), permissions for further reuse of content should be sought from the publisher or author.
Theme by 
Atmire NV