Publication:
Factors Associated with Relapse and Treatment of Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease in the United Kingdom

2

Issued Date

2021-01-01

Resource Type

Article

ISSN

25743805

DOI

10.1001/jamanetworkopen.2021.42780

Other identifier(s)

2-s2.0-85122593569

Rights

Mahidol University

Rights Holder(s)

SCOPUS

Bibliographic Citation

JAMA Network Open. (2021)

Suggested Citation

Chanjira Satukijchai, Romina Mariano, Silvia Messina, Mario Sa, Mark R. Woodhall, Neil P. Robertson, Lim Ming, Evangeline Wassmer, Rachel Kneen, Saif Huda, Anu Jacob, Camilla Blain, Christopher Halfpenny, Cheryl Hemingway, Eoin O'Sullivan, Jeremy Hobart, Leonora K. Fisniku, Roswell Martin, Ruth Dopson, Sarah A. Cooper, Victoria Williams, Patrick J. Waters, Sithara Ramdas, Maria Isabel Leite, Jacqueline Palace Factors Associated with Relapse and Treatment of Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease in the United Kingdom. JAMA Network Open. (2021). doi:10.1001/jamanetworkopen.2021.42780 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/78529

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Title

Factors Associated with Relapse and Treatment of Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease in the United Kingdom

Author(s)

Chanjira Satukijchai
 Romina Mariano
 Silvia Messina
 Mario Sa
 Mark R. Woodhall
 Neil P. Robertson
 Lim Ming
 Evangeline Wassmer
 Rachel Kneen
 Saif Huda
 Anu Jacob
 Camilla Blain
 Christopher Halfpenny
 Cheryl Hemingway
 Eoin O'Sullivan
 Jeremy Hobart
 Leonora K. Fisniku
 Roswell Martin
 Ruth Dopson
 Sarah A. Cooper
 Victoria Williams
 Patrick J. Waters
 Sithara Ramdas
 Maria Isabel Leite
 Jacqueline Palace

Other Contributor(s)

University Hospitals Sussex NHS Foundation Trust
 Siriraj Hospital
 Birmingham Women’s and Children’s NHS Foundation Trust
 The Walton Centre NHS Foundation Trust
 Cleveland Clinic Abu Dhabi
 Plymouth University, Peninsula Schools of Medicine and Dentistry
 Brighton and Sussex Medical School
 St George's University Hospitals NHS Foundation Trust
 Alder Hey Children's NHS Foundation Trust
 Cardiff University
 King's College Hospital
 Barts and The London School of Medicine and Dentistry
 Gloucestershire Hospitals NHS Foundation Trust
 Great Ormond Street Hospital for Children NHS Foundation Trust
 Aston University
 King's College London
 The Royal London Hospital
 John Radcliffe Hospital
 Guy's and St Thomas' NHS Foundation Trust
 University of Oxford Medical Sciences Division
 University Hospital Southampton NHS Foundation Trust
 Bangkok International Hospital
 University Hospitals Plymouth National Health Service Foundation Trust

Abstract

Importance: Longer-Term outcomes and risk factors associated with myelin oligodendrocyte glycoprotein antibody-Associated disease (MOGAD) are not well established. Objective: To investigate longer-Term risk of relapse and factors associated with this risk among patients with MOGAD. Design, Setting, and Participants: This large, single-nation, prospective cohort study was conducted among 276 patients with MOGAD at 5 health care centers in the UK. Data from January 1973 to March 2020 were collected from 146 patients at Oxford and its outreach sites, 65 patients at Liverpool, 32 patients at a children's hospital in Birmingham, 22 patients at a children's hospital in London, and 11 patients at Cardiff, Wales. Data were analyzed from April through July 2020. Main Outcomes and Measures: Risk of relapse and annualized relapse rate were evaluated according to different baseline features, including onset age, onset phenotype, and incident vs nonincident group, with the incident group defined as patients diagnosed with antibodies against myelin oligodendrocyte glycoprotein before a second attack. Time to next relapse among patients experiencing relapse was measured and compared between the maintenance therapy subgroup and each first-line treatment group. The no-Treatment group was defined as the off-Treatment phase among patients who were relapsing, which could occur between any attack or between the last attack and last follow-up. Results: Among 276 patients with MOGAD, 183 patients were identified as being part of the incident group. There were no differences in mean (SD) onset age between total and incident groups (26.4 [17.6] years vs 28.2 [18.1] years), and female patients were predominant in both groups (166 [60.1%] female patients vs 106 [57.9%] female patients). The most common presentation overall was optic neuritis (ON) (119 patients among 275 patients with presentation data [43.3%]), while acute disseminated encephalomyelitis (ADEM), brain, or brainstem onset was predominant among 69 patients aged younger than 12 years (47 patients [68.1%]), including 41 patients with ADEM (59.4%). In the incident group, the 8-year risk of relapse was 36.3% (95% CI, 27.1%-47.5%). ON at onset was associated with increased risk of relapse compared with transverse myelitis at onset (hazard ratio [HR], 2.66; 95% CI, 1.01-6.98; P =.047), but there was no statistically significant difference with adjustment for a follow-on course of corticosteroids. Any TM at onset (ie, alone or in combination with other presentations [ie, ON or ADEM, brain, or brain stem]) was associated with decreased risk of relapse compared with no TM (HR, 0.41; 95% CI, 0.20-0.88; P =.01). Young adult age (ie, ages >18-40 years) was associated with increased risk of relapse compared with older adult age (ie, ages >40 years) (HR, 2.71; 95% CI, 1.18-6.19; P =.02). First-line maintenance therapy was associated with decreased risk of relapse when adjusted for covariates (prednisolone: HR, 0.33; 95% CI, 0.12-0.92; P =.03; prednisolone, nonsteroidal immunosuppressant, or combined: HR, 0.51; 95% CI, 0.28-0.92; P =.03) compared with the no-Treatment group. Conclusions and Relevance: The findings of this cohort study suggest that onset age and onset phenotype should be considered when assessing subsequent relapse risk and that among patients experiencing relapse, prednisolone, first-line immunosuppression, or a combination of those treatments may be associated with decreased risk of future relapse by approximately 2-fold. These results may contribute to individualized treatment decisions.

Keyword(s)

Medicine

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URI

https://repository.li.mahidol.ac.th/handle/123456789/78529

Collections

Scopus 2021