Abstract Details

Title Myelin Oligodendrocyte Glycoprotein Antibody-associated Disease (MOGAD) Relapse Risk in a Contemporary, Population-based Cohort

Topic Autoimmune Neurology

Presentation(s) S6 - Autoimmune Neurology: NMOSD and MOGAD (2:24 PM-2:36 PM)

Poster/Presentation
Number 008

Objective To determine relapse risk among incident myelin oligodendrocyte glycoprotein antibody–associated disease (MOGAD) patients in a contemporary population-based cohort.

Background Prior studies likely overestimated MOGAD relapse risk because many didn’t exclude patients diagnosed due to relapses, were conducted prior to widespread availability of testing, and/or were not population-based.

Design/Methods

We conducted a retrospective cohort study of MOGAD patients with symptom onset 1/1/2019-12/31/2024 who were diagnosed prior to a relapse from the population-based membership of Kaiser Permanente Southern California. Electronic health records were manually reviewed for outcomes and covariates.

Results We identified 69 patients diagnosed prior to relapse. 30 (43.5%) were under 18 years old and 36 (52.2%) were female. Most (82.3%) made full recoveries, only 3 (4.3%) were left with moderate-to-severe deficits (all non-relapsers), even though 56.5% had severe deficits at nadir. After a median follow-up of 32.9 months (IQR=23.0-48.9), only 3 (10%) pediatric and 5 (12.8%) adult patients relapsed. Relapses occurred shortly after symptom onset (median=2.8 months, IQR=2.2-8.1). Once prophylactic treatment was initiated in relapsing patients, no further relapses occurred. Treatment was initiated shortly after symptom onset in most patients (n=65), primarily with corticosteroids (n=63, median=8 days, IQR=5-17). 31.9% received additional acute treatment but empiric prophylaxis was uncommon (15.9% total, 8.7% for diagnostic uncertainty). The length of corticosteroids ranged from 0-135 days (median=15) and longer tapers were not associated with reduced risk of relapse. The only clinical, laboratory or demographic characteristics associated with an increased risk of relapse was living an area with a higher social vulnerability index (100% relapsers, 62.2% non-relapsers), although this did not reach statistical significance (p=0.078).

Conclusions These findings are reassuring for newly diagnosed people with MOGAD because if acute treatment is started promptly, the risk of relapses and permanent deficits is low. These findings do not support initiating empiric prophylaxis or prolonged corticosteroid tapers in most new-onset MOGAD patients.

Authors/Disclosures
Annette M. Langer-Gould, MD, PhD (Kaiser Permanente Southern California) PRESENTER	An immediate family member of Dr. Langer-Gould 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 Annals of American Thoracic Society. The institution of Dr. Langer-Gould has received research support from PCORI. The institution of an immediate family member of Dr. Langer-Gould has received research support from PCORI, ARQ, NIH. Dr. Langer-Gould has a non-compensated relationship as a Voting Member with ICER CTAF Panel that is relevant to AAN interests or activities.
Jason Scott, Jr., medical student	Mr. Scott has nothing to disclose.
Fernando Torres	Fernando Torres has nothing to disclose.
Jessica B. Smith, MPH (Kaiser Permanente)	Ms. Smith has nothing to disclose.

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