Time to Treat First Acute Attack of Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease,JAMA Neurology

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Time to Treat First Acute Attack of Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease
JAMA Neurology ( IF 20.4 ) Pub Date : 2024-09-03 , DOI: 10.1001/jamaneurol.2024.2811
Young Nam Kwon _{1,

2} , Boram Kim ₃ , Jun-Soon Kim ₄ , Kyung Seok Park ₄ , Da-Young Seo ₅ , Hyunjin Kim ₅ , Eun-Jae Lee ₅ , Young-Min Lim ₅ , Hyunjin Ju ₆ , Yeon Hak Chung ₇ , Ju-Hong Min ₈ , Tai-Seung Nam ₉ , Sooyoung Kim ₁₀ , Eunhee Sohn ₁₀ , Kyong Jin Shin ₁₁ , Jin Myoung Seok ₁₂ , Sunyoung Kim ₁₃ , Jong Seok Bae ₁₄ , Sukyoon Lee ₁₅ , Seong-Il Oh ₁₆ , Yu Jin Jung ₁₇ , Jinseok Park ₁₈ , Seung Hyun Kim ₁₈ , Ki Hoon Kim _{19,

20} , Ho Jin Kim ₁₉ , Jae Ho Jung ₂₁ , Seong-Joon Kim ₂₁ , Seung Woo Kim ₁ , Myoung-Jin Jang ₂₂ , Jung-Joon Sung ₃ , Patrick Waters ₂₃ , Ha Young Shin ₁ , Sung-Min Kim _{2,

3}

Affiliation

Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
Biomedical Research Institute, Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea.
Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Gyeonggi-do, Republic of Korea.
Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Department of Neurology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea.
Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Department of Neurology, Chonnam National University Medical School, Gwangju, Republic of Korea.
Department of Neurology, Chungnam National University College of Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea.
Department of Neurology, Haeundae-Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea.
Department of Neurology, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Republic of Korea.
Department of Neurology, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Republic of Korea.
Department of Neurology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea.
Department of Neurology, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea.
Department of Neurology, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Republic of Korea.
Department of Neurology, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Department of Neurology, College of Medicine, Hanyang University, Seoul, Republic of Korea.
Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Republic of Korea.
Department of Neurology, Inje University Sanggye Paik Hospital, Seoul, Korea.
Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea.
Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Republic of Korea.
Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, United Kingdom.

ImportanceA proportion of people with myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) have a relapsing disease course and persistent anti–myelin oligodendrocyte glycoprotein immunoglobulin G (MOG-IgG) seropositivity. Few studies have investigated whether treatment of the first MOGAD attack is associated with the long-term disease course and/or MOG-IgG seronegative conversion.ObjectiveTo investigate the association of time to treat the first acute MOGAD attack with relapse risk and MOG-IgG serostatus.Design, Setting, and ParticipantsThis was a retrospective, nationwide, multicenter cohort study involving 14 secondary or tertiary hospitals in South Korea between November 2009 and August 2023. People with adult-onset MOGAD, who either had a relapse or were followed up for more than 12 months after disease onset and had a detailed medical record of their first attack, were included. Individuals were excluded for adolescent-onset MOGAD or short disease duration.ExposuresPatients were categorized based on the time to treat the first acute MOGAD attack: early (&lt;5 days), intermediate (5-14 days), and late (not treated within 14 days).Main Outcomes and MeasuresA multivariable analysis for clinical and treatment factors associated with relapsing disease course and/or MOG-IgG seronegative conversion. Further subgroup analyses were conducted among those without long-term nonsteroidal immunosuppressant (NSIS) maintenance treatment.ResultsAmong the 315 individuals screened, 75 were excluded. A total of 240 patients (median [IQR] age at onset, 40.4 [28.8-56.1] years; 125 female [52.1%]) with median (IQR) disease duration of 3.07 (1.95-6.15) years were included. A total of 110 of 240 patients (45.8%) relapsed after a median (IQR) of 0.45 (0.18-1.68) years, and 29 of 116 patients (25.0%) experienced a conversion to seronegative MOG-IgG. Both the time to treatment of the first MOGAD attack (late vs early: adjusted hazard ratio [aHR], 2.64; 95% CI, 1.43-4.84; P = .002; intermediate vs early: aHR, 2.02; 95% CI, 1.10-3.74; P = .02) and NSIS maintenance treatment (aHR, 0.24; 95% CI, 0.14-0.42; P &lt; .001) were independently associated with the risk of relapse. In a subgroup without NSIS maintenance, the time to treat of the first MOGAD attack was still associated with higher risk of relapse (late vs early: aHR, 3.51; 95% CI, 1.64-7.50; P = .001; intermediate vs early: aHR, 2.68; 95% CI, 1.23-5.85; P = .01). Lastly, the time to treat of the first MOGAD attack was also associated with MOG-IgG seronegative conversion (early vs late: adjusted odds ratio, 7.04; 95% CI, 1.58-31.41; P = .01), whereas NSIS maintenance treatment was not.Conclusions and RelevanceResults of this cohort study suggest that early treatment of the first acute MOGAD attack was associated with a reduction in the proportion of relapsing disease course and an increase in the likelihood of MOG-IgG seronegative conversion. These data suggest that timing of acute phase treatment for the first MOGAD attack can be associated with the long-term prognosis and autoimmune status of patients.

更新日期：2024-09-03

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