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Abstract Details

Age-Dependent Risk Factors for Relapses in MOGAD Patients
Autoimmune Neurology
S38 - NMOSD, MOGAD, Demyelinating, and Other (2:24 PM-2:36 PM)
008

To assess age-dependent risk factors associated with relapses in patients with Myelin Oligodendrocyte Glycoprotein Antibody Disease (MOGAD).

Patients with MOGAD exhibit significant heterogeneity in clinical presentation and treatment responses. However, the impact of patient age on the disease course remains unclear.

We conducted a retrospective cohort analysis using our clinical database comprising MOGAD cases followed at the Mass General Brigham system in Boston. The primary outcome was relapses. Cox-proportional mixed-effect models were used to calculate hazard ratios (HRs) for multiple relapses.

A total of 256 patients were included in the study. Multivariate Cox regression analysis showed that, compared to patients aged 30-45, patients aged 45 years or older and patients aged less than 30 years exhibited a higher risk of relapses. The change in HR across all ages revealed a U-shaped risk curve, indicating that patients at both ends of the age spectrum are more susceptible to relapses. When compared to no treatment, IVIG (intravenous immunoglobulin) consistently showed a lower relative risk of relapses across all age groups. In contrast, rituximab demonstrated a down-trending relative risk with increasing age, and the model estimate indicated that reduced risk of relapses with rituximab was only observed in patients older than approximately 30 years. Subgroup analysis revealed that in younger patients, cerebral syndrome was linked to a lower risk of relapses. Conversely, in older patients, optic neuritis were associated with a higher risk of relapses.

Our findings underscore the importance of considering age-related factors in MOGAD management. While rituximab is one of the mainstays in maintenance therapy, it appears to confer a protective effect primarily in older patients in our cohort. In contrast, IVIG is consistently associated with favorable outcomes across all ages. These insights can guide personalized treatment strategies for patients with MOGAD.
Authors/Disclosures
Takahisa Mikami, MD (Massachusetts General Hospital)
PRESENTER 		Dr. Mikami has nothing to disclose.
Philippe-Antoine Bilodeau, MD (Massachusetts General Hospital) Dr. Bilodeau has nothing to disclose.
Monique Anderson, MD, PhD (Mass General Hospital) Dr. Anderson has nothing to disclose.
Rebecca Salky Rebecca Salky has nothing to disclose.
Gabriela Romanow (Massachusetts General Hospital) Gabriela Romanow has nothing to disclose.
Mattia Wruble, MD The institution of Dr. Wruble has received research support from Alexion. The institution of Dr. Wruble has received research support from Roche.
Melanie Delgado (NIH) Melanie Delgado has nothing to disclose.
Rebecca L. Gillani, MD (Massachusetts General Hospital) The institution of Dr. Gillani has received research support from NIH/NINDS. The institution of Dr. Gillani has received research support from The Phyllis and Jerome Lyle Rappaport Foundation. The institution of Dr. Gillani has received research support from McCourt Foundation .
Anastasia Vishnevetsky, MD (Massachusetts General Hospital) The institution of Dr. Vishnevetsky has received research support from National MS Society. The institution of Dr. Vishnevetsky has received research support from NIH (NeuroNext).
Michael Levy, MD, PhD, FAAN (Massachusetts General Hospital/Harvard Medical School) Dr. Levy has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Mitsubishi Pharma. Dr. Levy has received personal compensation in the range of $500-$4,999 for serving as a Consultant for UCB Pharma. Dr. Levy has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Sanofi. Dr. Levy 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. Levy has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Horizon. Dr. Levy has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. Dr. Levy has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Elsevier. Dr. Levy has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Various law firms. The institution of Dr. Levy has received research support from National Institutes Health.