Abstract Details

Title Timing and Predictors of T2-Lesion Resolution in MOGAD

Topic Autoimmune Neurology

Presentation(s) P13 - Poster Session 13 (8:00 AM-9:00 AM)

Poster/Presentation
Number 6-028

Objective

To determine the timing of T2-lesion resolution and its predictors in myelin-oligodendrocyte glycoprotein antibody-associated disease (MOGAD).

Background

MOGAD T2-lesions often resolve over time, differing from other demyelinating disorders. Studies assessing the timing and predictors of T2-lesion resolution are lacking, yet may improve our understanding of its pathophysiology and guide the timing of follow-up MRI.

Design/Methods

We retrospectively included 63 patients (pediatric-onset 17, 27%) with a MOGAD diagnosis, >2 MRIs, and >1 brain or spinal lesion. A lesion-diameter of ≥1 cm was required to avoid non-inflammatory lesions. T2-lesion resolution was assessed on all available scans. The association between patient and intrinsic lesion factors and lesion resolution over 12 months was assessed with age-, sex- and lesion diameter/length-adjusted generalized estimating equations.

Results

We studied 404 T2-lesions (brain, 314[78%]; spinal cord, 90[22%]). Median (interquartile range) follow-up duration and number of scans per patient were 46 (13-74) months, 5 (3-8) brain and 4 (2-8) spinal cord, respectively. At last MRI, 287 lesions (71%) resolved, with a median (interquartile range) time-to-resolution of 4 months (2-12). Among patient factors, concomitant optic neuritis was associated with a lower likelihood of resolution (odds ratio [95% confidence interval] -0.93 [-1.76; -0.10], p=0.028). Acute treatment (steroids, immunoglobulins or plasma-exchange) had no effect (-0.57 [-1.21; 0.07], p=0.08), and in those receiving no acute treatment spontaneous resolution occurred in 17/35 lesions (49%). Among intrinsic lesion features, deep grey matter location increased the likelihood of resolution (1.08 [0.25; 1.91], p=0.011), while T1-hypointensity (-1.21 [-1.82; -0.59], p<0.001) decreased the likelihood of resolution. High-antibody titer, pediatric-onset, location in brain vs. spinal cord, and oligoclonal bands were not predictive of lesion resolution.

Conclusions

MOGAD T2-lesions usually resolve within one year irrespective of acute treatment. This likely reflects the distinct pathogenesis of MOGAD rather than treatment response and may help in differentiating from multiple sclerosis.

Authors/Disclosures
Laura Cacciaguerra, MD, PhD (Mayo Clinic) PRESENTER	Dr. Cacciaguerra has nothing to disclose.
Vyanka Redenbaugh, MB BCh BAO (Mayo Clinic)	Dr. Redenbaugh 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. John Chen has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for UCB.
Elia Sechi, MD (University of Sassari)	Dr. Sechi has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Alexion. Dr. Sechi has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Argenx.
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 .
Jan-Mendelt Tillema, MD (Mayo Clinic)	Dr. Tillema has nothing to disclose.
Massimo Filippi, MD, FAAN (Ospedale San Raffaele, Neuroimaging Research Unit)	Dr. Filippi has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Alexion, Almirall, Biogen, Merck, Novartis, Roche, Sanofi. Dr. Filippi has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion, Biogen, Bristol-Myers Squibb, Merck, Novartis, Roche, Sanofi, Sanofi-Aventis, Sanofi-Genzyme, Takeda. Dr. Filippi has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Bayer, Biogen, Celgene, Chiesi Italia SpA, Eli Lilly, Genzyme, Janssen, Merck-Serono, Neopharmed Gentili, Novartis, Novo Nordisk, Roche, Sanofi, Takeda, and TEVA. Dr. Filippi has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Springer Nature. The institution of Dr. Filippi has received research support from Biogen Idec, Merck-Serono, Novartis, Roche, the Italian Ministry of Health, the Italian Ministry of University and Research, and Fondazione Italiana Sclerosi Multipla.
Maria A. Rocca (Neuroimaging Research Unit)	Maria Assunta Rocca has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biogen, Bristol Myers Squibb, Eli Lilly, Janssen, Roche. Maria Assunta Rocca has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for AstraZaneca, Biogen, Bristol Myers Squibb, Bromatech, Celgene, Genzyme, Horizon Therapeutics Italy, Merck Serono SpA, Novartis, Roche, Sanofi and Teva. The institution of Maria Assunta Rocca has received research support from MS Society of Canada, the Italian Ministry of Health, the Italian Ministry of University and Research, and Fondazione Italiana Sclerosi Multipla.
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 Arialys. 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. 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. 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 $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 UCB. The institution of Dr. Flanagan has received research support from Roche. The institution of Dr. Flanagan has received research support from UCB. The institution of Dr. Flanagan has received research support from Merck. 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 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. Dr. Flanagan has a non-compensated relationship as a Editorial Board Member with Neurology that is relevant to AAN interests or activities.

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