Abstract Details

Title Development of new or enlarging MRI lesions outside of attacks is rare in myelin oligodendrocyte glycoprotein antibody-associated disease

Topic Autoimmune Neurology

Presentation(s) S3 - Autoimmune Neurology 1: Mechanisms of Disease, Clinical Practice (1:36 PM-1:48 PM)

Poster/Presentation
Number 004

Objective To determine the frequency of new/enlarging T2 or enhancing asymptomatic lesions in myelin-oligodendrocyte-glycoprotein-antibody-associated-disease (MOGAD) and compare to multiple sclerosis (MS) and aquaporin-4 antibody-positive-neuromyelitis-optica-spectrum-disorder (AQP4+NMOSD).

Background Data on new asymptomatic lesions in MOGAD is limited.

Design/Methods We retrospectively identified Mayo Clinic MOGAD patients (1/1/2000-3/1/2021) with inclusion criteria of: 1)MOG-IgG positivity by live-cell-based-assay; 2)Fulfilling MOGAD criteria; 3)Follow-up non-attack MRI and prior reference MRI available without interval attacks. A neurologist/neuroradiologist reviewed follow-up T2-FLAIR (brain), T2 (spine), and T1-post-gadolinium (brain and spine) images. Demyelinating brain/spinal lesions on follow-up MRI (if present) were compared to the reference MRI to identify new/enlarging lesions. A subset of MOGAD MRI scans were compared to scans from MS and AQP4+NMOSD patients with similar interval between images.

Results We included 105 MOGAD patients (median age, 31 years[range, 3-80]; 60% female) with 381 non-attack follow-up MRIs. In total, 11/381 (3%) scans had one or more new (n=10[single, 4; multiple, 6]) or enlarging (n=1) T2-lesions (brain, 10/215[5%]; spine, 1/166[0.6%]) with 6/11 (55%) enhancing; one scan (0.3%) had increased enhancement alone. The median follow-up interval between MRIs was 7 months (range, 0-133) and just 44/105 (42%) patients were on maintenance immunosuppression. When comparing a subset of MOGAD paired MRIs to MS and AQP4+NMOSD paired MRIs with similar interval between scans (median months[range]; MOGAD, 25[17-133]; MS, 22.5[7-138]; p=0.77; AQP4+NMOSD (44[6-37]; p=0.53), new brain lesions were less in MOGAD (1/25[4%]) than MS (14/26[54%], p<0.0001) but did not differ from AQP4+NMOSD (1/13[8%], p=1.0). New spinal lesions were rare (0-5%) and did not differ between groups.

Conclusions New brain MRI lesions rarely develop outside of attacks in MOGAD which differs from MS in which asymptomatic lesions develop more commonly. In contrast to MS, asymptomatic brain MRI surveillance in MOGAD may have limited utility as a surrogate biomarker of disease activity in clinical practice and for clinical trials.

Authors/Disclosures
Stephanie Syc-Mazurek, MD, PhD (Mayo Clinic) PRESENTER	Dr. Syc-Mazurek has a non-compensated relationship as a Editorial Board Resident and Fellows Section with Neurology that is relevant to AAN interests or activities.
Elia Sechi, MD (University of Sassari)	Dr. Sechi has nothing to disclose.
John Chen	John Chen has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for UCB. John Chen has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Amgen.
	No disclosure on file
Karl Krecke	Karl Krecke has nothing to disclose.
	No disclosure on file
Jan-Mendelt Tillema, MD (Mayo Clinic)	Dr. Tillema has nothing to disclose.
Alfonso S. Lopez, MD (Mayo Clinic)	Dr. Lopez has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Horizon. Dr. Lopez has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech .
Claudia F. Lucchinetti, MD, FAAN (University of De Medical School, Health Learning Blg)	The institution of Dr. Lucchinetti has received research support from Biogen Idec. The institution of Dr. Lucchinetti has received research support from NIH/NINDS. The institution of Dr. Lucchinetti has received research support from National Institute of Neurological Disorders and Stroke . The institution of Dr. Lucchinetti has received research support from National Multiple Sclerosis Society. The institution of Dr. Lucchinetti has received research support from National Center for Advancing Translational Sciences. Dr. Lucchinetti has received intellectual property interests from a discovery or technology relating to health care. Dr. Lucchinetti has a non-compensated relationship as a Member with National Institute of Neurological Disorders that is relevant to AAN interests or activities. Dr. Lucchinetti has a non-compensated relationship as a Member with Board of Directors, Association of University Professors of Neurology that is relevant to AAN interests or activities. Dr. Lucchinetti has a non-compensated relationship as a Member with Mayo Clinic Board of Trustees that is relevant to AAN interests or activities. Dr. Lucchinetti has a non-compensated relationship as a Member with Mayo Clinic Board of Governors that is relevant to AAN interests or activities.
Nicholas L. Zalewski, MD (Mayo Clinic)	Dr. Zalewski has nothing to disclose.
Marina Buciuc, MD (MUSC)	Dr. Buciuc has nothing to disclose.
M. Tariq Bhatti, MD (Kaiser Permanente, Northern California)	Dr. Bhatti has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Receptos . Dr. Bhatti has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for NIH LHON gene therapy study .
Sean J. Pittock, MD, FAAN (Mayo Clinic Dept of Neurology)	Dr. Pittock has received personal compensation in the range of $500-$4,999 for serving as a Consultant for UCB. Dr. Pittock has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Arialys Therapeutics. The institution of Dr. Pittock has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. Dr. Pittock has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Arialys. The institution of Dr. Pittock has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for UCB. The institution of Dr. Pittock has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche/Genentech. The institution of Dr. Pittock has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Alexion/AstraZeneka. The institution of Dr. Pittock has received research support from NIH. The institution of Dr. Pittock has received research support from Alexion/AstraZeneka. The institution of Dr. Pittock has received research support from F. Hoffman/LaRoche/Genentech. Dr. Pittock has received intellectual property interests from a discovery or technology relating to health care. Dr. Pittock has received intellectual property interests from a discovery or technology relating to health care. Dr. Pittock has received publishing royalties from a publication relating to health care.
Eoin P. Flanagan, MBBCh, FAAN (Mayo Clinic)	The institution of Dr. Flanagan has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. Dr. Flanagan has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. Dr. Flanagan has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Horizon Therapeutics. The institution of Dr. Flanagan has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. Dr. Flanagan has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Pharmacy times. The institution of Dr. Flanagan has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for UCB. The institution of Dr. Flanagan has received research support from Viela Bio. The institution of Dr. Flanagan has received research support from UCB. The institution of Dr. Flanagan has received research support from Roche. Dr. Flanagan has received publishing royalties from a publication relating to health care. Dr. Flanagan has a non-compensated relationship as a Member of medical Advisory Board with The MOG Project that is relevant to AAN interests or activities. Dr. Flanagan has a non-compensated relationship as a Editorial board member with Journal of The Neurologic Sciences that is relevant to AAN interests or activities. Dr. Flanagan has a non-compensated relationship as a Editorial board member with Neuroimmunology Reports that is relevant to AAN interests or activities. Dr. Flanagan has a non-compensated relationship as a Editorial Board Member with Neurology, Neuroimmunology Neuroinflammation (N2) Journal that is relevant to AAN interests or activities.

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