The following is a summary of “Early Maintenance Treatment Initiation and Relapse Risk Mitigation After a First Event of MOGAD in Adults: The MOGADOR2 Study,” published in the July 2024 issue of Neurology by Deschamps et al.

Due to its recent discovery, the long-term course of myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) remains unclear.

Researchers conducted a retrospective study investigating the long-term course of MOGAD in adults, including factors influencing relapse risk and neurological outcomes.

They gathered clinical and biological information from patients experiencing their first MOGAD event, part of France’s nationwide incident cohort (February 2014 to March 2017). Those 18 years and older were eligible at onset and monitored for at least 3 months. Prospective data collection continued (July 2023) into the dedicated French database, covering every relapse, including phenotype details, last assessment date, final clinical outcomes like Expanded Disability Status Scale score and visual acuity, and maintenance therapy. Recurrence-free survival likelihood was analyzed via the Kaplan-Meier method.

The results showed 128 patients included, 81 (63.3%) had isolated optic neuritis, and 25 (19.5%) had isolated myelitis at onset. The median follow-up lasted 77.8 months (range 3.2–111.2), with 49 patients (38.3%) experiencing at least one relapse. Median times for the second and third attacks were 3.2 (1.0–86.2) and 13.0 (2.6–64.4) months, respectively. At the last assessment, 22 (17.2%) patients had an Expanded Disability Status Scale Score ≥3, and 6 (4.7%) had a score ≥6. About 80 patients received maintenance treatment, with 47 (36.7%) starting after the first attack and 25 (19.5%) after the second. Multivariate analysis indicated that initiating therapy after the first attack was associated with lower relapse risk (OR = 0.26 [95% CI 0.11–0.62], p = 0.002). Patients starting treatment after the first attack had 2-year, 4-year, 6-year, and 8-year relapse risks of 11%, 15%, 20%, and 20%, respectively, compared to 41%, 46%, 51%, and 56% in others.

Investigators concluded that early relapses are most common in MOGAD, and starting preventive treatment after the first episode significantly lowered relapse rates.

Source: neurology.org/doi/10.1212/WNL.0000000000209624