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Article Dans Une Revue Neurology Année : 2024

Early Maintenance Treatment Initiation and Relapse Risk Mitigation After a First Event of MOGAD in Adults

Jessica Guillaume
  • Fonction : Auteur
Bertrand Audoin
Elisabeth Maillart
Nicolas Collongues
Mikael Cohen
Xavier Ayrignac
Eric Thouvenot
Bertrand Bourre
Paul Cantagrel
  • Fonction : Auteur
Sebastien Cabasson
  • Fonction : Auteur
Nicolas Maubeuge
  • Fonction : Auteur
Karolina Hankiewicz
  • Fonction : Auteur
Chantal Nifle
  • Fonction : Auteur
Eric Berger
Hana Megherbi
  • Fonction : Auteur
Laurent Magy
Frederic Klapczynski
  • Fonction : Auteur
Mariana Sarov Riviere
  • Fonction : Auteur
Claire Giannesini
  • Fonction : Auteur
Lorraine Hamelin
  • Fonction : Auteur
Marianne Giroux
  • Fonction : Auteur
Pierre Branger
Aude Maurousset
Guillaume Mathey
  • Fonction : Auteur
Maximilien Moulin
Nicolas Mélé
  • Fonction : Auteur
Caroline Papeix
Romain Marignier

Résumé

Background and objectives: Because myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a recently identified autoimmune disorder, the natural history of MOGAD is still not well described. The objective of this study was to describe the long-term outcomes of adult patients with MOGAD. In addition, we aimed to identify factors affecting relapse risk and neurologic outcomes. Methods: Clinical and biological data were obtained from patients with a first event of MOGAD and included in the French nationwide incident cohort between February 2014 and March 2017. Only patients aged 18 years or older at disease onset and with observation period of at least 3 months were included. Data were collected prospectively until July 2023 and registered in the dedicated French nationwide database. This form includes every relapse with phenotype description during follow-up, date of last assessment, final clinical outcome with Expanded Disability Status Scale score and visual acuity, and maintenance therapy. The probability of recurrence-free survival was assessed using the Kaplan-Meier method. Results: We included 128 patients. The onset phenotype was isolated optic neuritis in 81 patients (63.3%) and isolated myelitis in 25 patients (19.5%). The median follow-up duration was 77.8 months (range 3.2-111.2), with 49 patients (38.3%) experienced at least one relapse. Median times from onset to second and third attacks were 3.2 (1.0-86.2) and 13.0 (2.6-64.4) months, respectively. At the last assessment, Expanded Disability Status Scale Score was ≥3 and ≥6 in 22 (17.2%) and 6 (4.7%) patients, respectively. Eighty patients received at least one maintenance treatment. This treatment was initiated after the first attack in 47 patients (36.7% of the whole cohort) and at the time of a second attack in 25 (19.5%). Multivariate analysis revealed that initiating maintenance treatment after the first attack was associated with a lower relapse risk (OR = 0.26 [95% CI 0.11-0.62], p = 0.002). In patients receiving maintenance therapy after first attack, the 2-year, 4-year, 6-year, and 8-year relapse risks were 11%, 15%, 20%, and 20%, respectively. In other patients, the risks were 41%, 46%, 51%, and 56%. Discussion: The highest risk of a relapse in MOGAD occurs early, and initiating maintenance therapy from the first attack substantially reduced the relapse risk. Classification of evidence: This study provides Class III evidence that initiating maintenance therapy from the first attack in patients with MOGAD reduces the relapse risk.

Domaines

Neurosciences
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Dates et versions

hal-04653985 , version 1 (19-07-2024)

Identifiants

Citer

Romain Deschamps, Jessica Guillaume, Jonathan Ciron, Bertrand Audoin, Aurélie Ruet, et al.. Early Maintenance Treatment Initiation and Relapse Risk Mitigation After a First Event of MOGAD in Adults. Neurology, 2024, 103 (3), pp.e209624. ⟨10.1212/WNL.0000000000209624⟩. ⟨hal-04653985⟩
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