Abstract Details

Title Late Adult Onset Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease: Clinical Characterization and Predictors of Outcome

Topic Autoimmune Neurology

Presentation(s) P7 - Poster Session 7 (5:00 PM-6:00 PM)

Poster/Presentation
Number 8-005

Objective

To assess the frequency, characteristics and outcomes of late adult onset Myelin oligodendrocyte glycoprotein antibody-associated disease (LO-MOGAD) and compare to early adult onset (EO-MOGAD).

Background

Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) can occur at any age, but data regarding LO-MOGAD are scant.

Design/Methods Patients diagnosed with MOGAD per current diagnostic criteria with age at onset ≥50 years-old were included. Clinical, laboratory, radiological, treatment and outcome data were retrospectively collected. We compared: a) patients with age at onset 50-59 and ≥60 years-old; and b) LO-MOGAD ≥50 years-old to n=141 patients with EO-MOGAD (age range:18-49). Binary logistic regression was performed to find predictors of disability and relapsing course at last follow-up.

Results

We included 107 patients, representing 25% of the patients in the Mayo Clinic MOGAD database (n=436). Median age at onset was 59 years-old (range: 50-88) and 71 (66%) were female. Medical comorbidities were noted in 86/105 (83%). Optic neuritis was the most frequent phenotype at onset (77/107, 72%); median Expanded Disability Status Scale (EDSS) at nadir was 3 (range:1-9). In 32/107 (30%) cases a potential trigger was noted, mostly infections. In 32 patients (30%) an alternative diagnosis was assigned, most commonly giant cell arteritis (n=15). By a median follow-up of 22 months (range: 0-306), 50 (47%) patients had a relapsing course, and preventive treatment was administered in 53 (50%). Medication side effects were common (41/107, 38%). Follow-up duration predicted relapses; EDSS at nadir predicted residual disability. No differences were observed in patients aged 50-59 versus ≥60 years. Compared to EO-MOGAD, LO-MOGAD had more optic nerve, brainstem/cerebellar involvement and cognitive decline (p<0.05) and less frequent myelitis (p<0.05). EDSS and relapsing disease course were similar.

Conclusions

LO-MOGAD accounts for 1/4 of cases and optic neuritis is the dominant phenotype. In this age group, MOGAD is under-recognized and frequently misdiagnosed. Outcomes in LO-MOGAD and EO-MOGAD are comparable.

Authors/Disclosures
Eoin P. Flanagan, MBBCh, FAAN (Mayo Clinic) PRESENTER	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.
Alessandro Dinoto, MD	The institution of Dr. Dinoto has received research support from Encephalitis International . The institution of Dr. Dinoto has received research support from Autoimmune Encephalitis Alliance.
Laura Cacciaguerra, MD, PhD (Mayo Clinic)	Dr. Cacciaguerra has nothing to disclose.
Nisa Vorasoot, MD	Dr. Vorasoot has nothing to disclose.
Vyanka Redenbaugh, MB BCh BAO (Mayo Clinic)	Dr. Redenbaugh 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 .
Cristina Valencia Sanchez, MD (Mayo Clinic Arizona)	Dr. Valencia Sanchez has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for TG therapeutics. Dr. Valencia Sanchez has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Merck. Dr. Valencia Sanchez has a non-compensated relationship as a member of the medical advisory board with The MOG Project that is relevant to AAN interests or activities.
Kai Guo, MD, PhD	Dr. Guo has nothing to disclose.
Smathorn Thakolwiboon, MD (Mayo Clinic Health System)	Dr. Thakolwiboon has nothing to disclose.
Susan Horsman, PharmD	Dr. Horsman has nothing to disclose.
Stephanie Syc-Mazurek, MD, PhD (Mayo Clinic)	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.
Nanthaya Tisavipat, MD (Mayo Clinic)	Miss Tisavipat has nothing to disclose.
Deena Tajfirouz, MD	Dr. Tajfirouz has nothing to disclose.
Eric R. Eggenberger, DO, FAAN (Mayo Clinic Florida)	Dr. Eggenberger has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Welch-Allyn. Dr. Eggenberger has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Illinois Institute of Technology (IITT). Dr. Eggenberger has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Argenx.
Misha Pless, MD (Mayo Clinic)	Dr. Pless has nothing to disclose.
Kevin Chodnicki (Mayo Clinic)	Kevin Chodnicki has nothing to disclose.
Jan-Mendelt Tillema, MD (Mayo Clinic)	Dr. Tillema has nothing to disclose.
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.
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.

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