The long‐term outcome of MOGAD: An observational national cohort study of 61 patients

Abstract

Background and objective The prognosis in myelin oligodendrocyte glycoprotein (MOG) antibody‐associated disease (MOGAD) is a matter of debate. Our aim was to assess the long‐term outcomes of patients with MOGAD. Methods We retrospectively analysed the clinical and paraclinical data of patients from the French nationwide observatory study NOMADMUS who tested positive for MOG antibodies (MOG‐IgG) and who had clinical follow‐up of at least 8 years from their first episode. Results Sixty‐one patients (median [range] age at onset 27 [3–69] years), with a median (mean; range) follow‐up of 177 (212.8; 98–657) months, were included. Among 58 patients with a relapsing course, 26.3% relapsed in the first year after onset. Of the 61 patients, 90.2% experienced at least one episode of optic neuritis. At last visit, the median (mean; range) Expanded Disability Status Scale (EDSS) score was 1 (2.12; 0–7.5), 12.5% had an EDSS score ≥6 and 37.5% had an EDSS score ≥3. Of 51 patients with final visual acuity (VA) data available, 15.7% had VA ≤0.1 in at least one eye and 25.5% had VA ≤0.5 in at least one eye. Bilateral blindness (VA ≤0.1) was present in 5.9% of patients. Finally, 12.5% of patients presented bladder dysfunction requiring long‐term urinary catheterization. No factor associated significantly with a final EDSS score ≥3 or with final VA ≤0.1 was found. Conclusion Overall long‐term favourable outcomes were achieved in a majority of our patients, but severe impairment, in particular visual damage, was not uncommon.

Clinical Profile and Treatment Outcome in MOGAD: A Single-Center Case-Series Study in Guiyang, China

“…As with a recurrence of 44% in our study with a median short duration of 20 months, such a low recurrence rate (28–59%) was reported in cohorts with a shorter period of follow-up (median time 15–42 months) ( 5 , 30 – 32 ). By contrast, studies with long-term follow-up (75 months to 14 years) showed most patients (80–95%) had relapses eventually ( 27 , 28 , 33 ). One patient in the current study had a relapse 12 years later after onset, and then MMF was added to prevent further attack.…”

“…These findings indicate a favorable long-term outcome of MOGAD provided that timely and full therapies were given for each attack, which supports the results from other studies. In a multi-center cohort of 61 patients from France ( 27 ), the median EDSS score was 1 (range 0–7.5) after a median follow-up period of 177 months (range 98–657). In another study including 29 patients from Mayo Clinic ( 28 ), the median EDSS score was 2 (range 0–10) after a median follow-up period of 14 years (range 9–31).…”

Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease (MOGAD): A Review of Clinical and MRI Features, Diagnosis, and Management

“…Another study on 61 patients followed for a median of 15 (range, 8-55) years, reported a median EDSS at last follow-up of 1 (range, 0-7.5) with 12.5% of cases having an EDSS of ≥6. In the same study, 16% of patients remained blind in at least one eye (105). In most patients with MOGAD ON, recovery of visual acuity is generally very good, although irreversible visual loss and blindness may occur in a minority of cases (100, 105, 106).…”

CNS Demyelinating Attacks Requiring Ventilatory Support With Myelin Oligodendrocyte Glycoprotein or Aquaporin-4 Antibodies

“… 19 These attacks occurred in 2.8% of patients with MOGAD with 0% mortality, while a prior study reported 3 of 48 (6.3%) with neurogenic respiratory failure (rhombencephalitis 2, myelitis 1) and 33% mortality, although encephalopathy or seizure indications were not reported. 1 The better outcome in MOGAD vs AQP4-NMOSD may reflect the good recovery reported from most MOGAD attacks, 20 - 22 better supportive treatment, and more MOGAD episodes occurring recently and most occurring as the first attack without preexisting disability. The lower proportion of MOGAD requiring plasma exchange may be from the more rapid recovery with shorter duration of intubation, better response to corticosteroids in MOGAD, and plasma exchange being better studied in AQP4-NMOSD.…”