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

Autor:	Satukijchai C; Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom.; Neuroscience Center, Bangkok International Hospital, Bangkok, Thailand.; Division of Neurology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand., Mariano R; Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom., Messina S; Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom.; Department of Clinical Neurology, John Radcliffe Hospital, Oxford University Hospitals Trust, Oxford, United Kingdom., Sa M; Paediatric Neurology, Great Ormond Street Hospital for Children, London, United Kingdom., Woodhall MR; Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom., Robertson NP; Department of Neurology, Division of Psychological Medicine and Clinical Neuroscience, Cardiff University, University Hospital of Wales, Cardiff, United Kingdom., Ming L; Children's Neurosciences, Evelina London Children's Hospital at Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom.; Department of Women and Children's Health, School of Life Course Sciences, King's College London, United Kingdom., Wassmer E; Birmingham Women's and Children's National Health Service Foundation Trust, Birmingham, United Kingdom.; School of Life and Health Sciences, Aston University, Birmingham, United Kingdom., Kneen R; Alder Hey Children's National Health Service Foundation Trust, Liverpool, United Kingdom., Huda S; Department of Neurology, Walton Centre National Health Service Foundation Trust, Liverpool, United Kingdom., Jacob A; Department of Neurology, Walton Centre National Health Service Foundation Trust, Liverpool, United Kingdom.; Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates., Blain C; St George's University Hospitals National Health Service Foundation Trust, London, United Kingdom., Halfpenny C; University Hospitals Southampton National Health Service Foundation Trust, Southampton, United Kingdom., Hemingway C; Department of Paediatric Neurology, Great Ormond Street Hospital for Children, London, United Kingdom., O'Sullivan E; Department of Ophthalmology, Kings College Hospital, London, United Kingdom., Hobart J; Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, United Kingdom.; University Hospitals Plymouth National Health Service Foundation Trust, United Kingdom., Fisniku LK; University Hospitals Sussex National Health Service Foundation Trust, Brighton, United Kingdom.; Brighton and Sussex Medical School, Brighton, United Kingdom., Martin R; Gloucestershire Hospitals National Health Service Foundation Trust, Gloucestershire, United Kingdom., Dopson R; Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Queen Mary University London, London, United Kingdom.; Royal London Hospital, Barts Health National Health Service Foundation Trust, United Kingdom., Cooper SA; University Hospitals Sussex National Health Service Foundation Trust, Brighton, United Kingdom., Williams V; Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom., Waters PJ; Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom., Ramdas S; Department of Paediatric Neurology, John Radcliffe Hospital, Oxford, United Kingdom., Leite MI; Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom.; Department of Clinical Neurology, John Radcliffe Hospital, Oxford University Hospitals Trust, Oxford, United Kingdom., Palace J; Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom.; Department of Clinical Neurology, John Radcliffe Hospital, Oxford University Hospitals Trust, Oxford, United Kingdom.
Jazyk:	angličtina
Zdroj:	JAMA network open [JAMA Netw Open] 2022 Jan 04; Vol. 5 (1), pp. e2142780. Date of Electronic Publication: 2022 Jan 04.
DOI:	10.1001/jamanetworkopen.2021.42780
Abstrakt:	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.
Databáze:	MEDLINE
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