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Abstract Details

The Clinical Spectrum of patients with Discordant MOG-IgG Titers and MOGAD Diagnoses
Autoimmune Neurology
P7 - Poster Session 7 (8:00 AM-9:00 AM)
1-002
This study characterized the clinical spectrum of patients with discordant MOG-IgG titers and MOGAD diagnoses (high titer without MOGAD; low titer with MOGAD). 
The myelin-oligodendrocyte glycoprotein antibody-associated disease (MOGAD) criteria require (A) a core clinical demyelinating event, (B) positive MOG-IgG, and (C) exclusion of better diagnoses. MOG-IgG (titer ≥1:100) requires no additional findings, while low positive titer (<1:100) requires ≥1 supporting clinical or MRI features.   
Patients were tested for MOG-IgG from 2017 to 2024 at a single center. MOGAD criteria were applied. Patients were stratified by titer and disease characteristics.  

164 MOG-IgG+ patients were identified: 117 (71%) female, median age 37 (range 3-80). 97% were tested by live fluorescence-activated cell sorting, the remainder by fixed cell-based assay. 102 (62%) had MOGAD.  

84 patients were high titer MOG-IgG (≥1:100), 54 (64%) female, median age 34.5, range 3-80. 72 (86%) met criteria for MOGAD. 12 (14%), including 2 with titer 1:1,000, had alternative diagnoses: multiple sclerosis (MS, 4), malignancy (3), infection (1), immune checkpoint inhibitor related neurotoxicity (1), polyneuropathy (1), chronic pain (1), stroke (1). 1 patient had concurrent AQP4-IgG+ and lymphoma.  

80 patients were low titer MOG-IgG ( <1:100), 63 (79%) female, median age 38.5, range 3-80. 30 (38%) met MOGAD criteria, based on clinical and/or radiological features (longitudinally extensive transverse myelitis in 8, optic neuritis in 11, and both in 4), short segment myelitis with negative OCBs, and MRI without features of MS.  
MOG-IgG titers should be carefully interpreted. While most high titer cases reflect true MOGAD, some have alternative diagnoses. Conversely, low titer MOG-IgG in the correct clinical context can fulfill MOGAD. Understanding what drives titer variability and off-target positivity needs further research.  
Authors/Disclosures
Katherine Havard-Coiro, MD (Cleveland Clinic Foundation)
PRESENTER 		Dr. Havard-Coiro has nothing to disclose.
Mengke Du (Cleveland Clinic) Mengke Du has nothing to disclose.
Daniel Ontaneda, MD, PhD, FAAN (Cleveland Clinic) Dr. Ontaneda has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Ontaneda has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Genentech/Roche. Dr. Ontaneda has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biogen Idec. Dr. Ontaneda has received personal compensation in the range of $500-$4,999 for serving as a Consultant for BMS. Dr. Ontaneda has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Sanofi. The institution of Dr. Ontaneda has received research support from NIH. The institution of Dr. Ontaneda has received research support from PCORI. The institution of Dr. Ontaneda has received research support from NMSS. The institution of Dr. Ontaneda has received research support from Genetech.
Jeffrey A. Cohen, MD (Cleveland Clinic) Dr. Cohen has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Convelo. Dr. Cohen has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Astoria. Dr. Cohen has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Bristol Myers Squibb. Dr. Cohen has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Viatris. Dr. Cohen has received personal compensation in the range of $500-$4,999 for serving as a Consultant for PSI. Dr. Cohen has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Shionogi. Dr. Cohen has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Celltrion.
Amy Kunchok, MBBS (Cleveland Clinic - Mellen Centre) Dr. Kunchok 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 Neurology:Open Access Journal .