Abstract Details

Title Seasonality of Initial Attack Onset in AQP4+ NMOSD, MOGAD, and MS: Observations from a US-based Multicenter Cohort

Topic Autoimmune Neurology

Presentation(s) P3 - Poster Session 3 (5:00 PM-6:00 PM)

Poster/Presentation
Number 1-005

Objective To assess the seasonal variation of initial attack onset in AQP4+NMOSD, MOGAD and MS.

Background Seasonal variation in attacks of central nervous system (CNS) neuroinflammatory conditions has been reported, including in different underlying conditions with distinct pathophysiology, including multiple sclerosis (MS), aquaporin-4 IgG seropositive neuromyelitis optica spectrum disorder (AQP4+ NMOSD) and myelin oligodendrocyte glycoprotein antibody associated disease (MOGAD). However, reports regarding seasonal variation in MS, MOGAD and AQP4+NMOSD initial attack onset are conflicting.

Design/Methods This study included 318 AQP4+NMOSD, 420 MOGAD and 1,128 relapsing-onset MS participants, with initial attacks between January 2005 and May 2025, and documented month and year of disease onset. AQP4+NMOSD and MOGAD participants were included from 3 US centers, whereas MS participants were included from one center. Statistical analysis was performed using Friedman’s test and the Roger-modified Edward’s test to assess for a significant monthly variation in attack onset.

Results Among MOGAD patients, onset attack peaks were observed in November, January and March, with overall consistent findings across all 3 sites, and analyses were consistent with a statistically significant monthly variation (p<0.01 by both methods). In MS, onset attack peaks were observed in January, March and April, with analyses of monthly variation revealing borderline statistical significance (p=0.05 by Edward’s test and p<0.05 by Friedman’s test). In AQP4+NMOSD onset attack peaks across the overall cohort were observed in February and March but this pattern was not consistent across the 3 sites and analyses did not reveal a statistically significant monthly variation (p=0.21 by Edward’s test and p>0.10 by Freidman’s test).

Conclusions

Seasonal variation in initial attacks was prominent in MOGAD and to a lesser extent MS, but not detected in AQP4+NMOSD. This could reflect the more prominent influence of seasonally distributed environmental factors such as infectious triggers or vitamin D deficiency in initial MOGAD and MS presentations compared to AQP4+NMOSD.

Authors/Disclosures
Shuvro Roy, MD (University of Washington) PRESENTER	Dr. Roy has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Amgen. Dr. Roy 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. Roy 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. Roy has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. The institution of Dr. Roy has received research support from The Siegel Rare Neuroimmune Association.
Georgios Gakis, MD	Dr. Gakis has nothing to disclose.
Philippe-Antoine Bilodeau, MD (Massachusetts General Hospital)	Dr. Bilodeau has nothing to disclose.
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).
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.
Joao Vitor Mahler, MD	Dr. Mahler has received research support from The Sumaira Foundation.
Yana Said, MD	Dr. Said has nothing to disclose.
Angeliki Filippatou, MD (Johns Hopkins University School of Medicine)	Dr. Filippatou has nothing to disclose.
Yishang Huang, research data anlayst	Miss Huang has nothing to disclose.
Yujie Wang, MD (UW Northwest)	Dr. Wang has received personal compensation in the range of $500-$4,999 for serving as a Consultant for TG Therapeutics. The institution of Dr. Wang has received research support from Genentech. The institution of Dr. Wang has received research support from uniQure. The institution of Dr. Wang has received research support from NIH/NINDS.
Ellen M. Mowry, MD, FAAN (Johns Hopkins University)	Dr. Mowry has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Octave. Dr. Mowry has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for SetPoint. The institution of Dr. Mowry has received research support from Genentech/Roche. The institution of Dr. Mowry has received research support from Biogen. Dr. Mowry has received publishing royalties from a publication relating to health care.
Kathryn Fitzgerald, PhD (Johns Hopkins University)	Dr. Fitzgerald has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Setpoint Medical. The institution of Dr. Fitzgerald has received research support from NIH. The institution of Dr. Fitzgerald has received research support from National MS Society.
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.
Elias S. Sotirchos, MD (Johns Hopkins University)	Dr. Sotirchos 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. Sotirchos 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. Sotirchos has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Amgen. Dr. Sotirchos 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. The institution of Dr. Sotirchos has received research support from National Institutes of Health. The institution of Dr. Sotirchos has received research support from National Multiple Sclerosis Society. The institution of Dr. Sotirchos has received research support from Sumaira Foundation. The institution of Dr. Sotirchos has received research support from Genentech. The institution of Dr. Sotirchos has received research support from UCB. The institution of Dr. Sotirchos has received research support from Astoria Biologica. The institution of Dr. Sotirchos has received research support from Ad Scientiam. The institution of Dr. Sotirchos has received research support from Alexion. The institution of Dr. Sotirchos has received research support from Corevitas. Dr. Sotirchos has received personal compensation in the range of $500-$4,999 for serving as a Ad Hoc Reviewer with National Institutes of Health.

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