Clinical spectrum and prognostic value of CNS MOG autoimmunity in adults: The MOGADOR study

• Published in: Neurology Vol. 90; no. 21; p. e1858
• Main Authors: Cobo-Calvo, Alvaro, Ruiz, Anne, Maillart, Elisabeth, Audoin, Bertrand, Zephir, Helene, Bourre, Bertrand, Ciron, Jonathan, Collongues, Nicolas, Brassat, David, Cotton, Francois, Papeix, Caroline, Durand-Dubief, Francoise, Laplaud, David, Deschamps, Romain, Cohen, Mikaël, Biotti, Damien, Ayrignac, Xavier, Tilikete, Caroline, Thouvenot, Eric, Brochet, Bruno, Dulau, Cecile, Moreau, Thibault, Tourbah, Ayman, Lebranchu, Pierre, Michel, Laure, Lebrun-Frenay, Christine, Montcuquet, Alexis, Mathey, Guillaume, Debouverie, Marc, Pelletier, Jean, Labauge, Pierre, Derache, Nathalie, Coustans, Marc, Rollot, Fabien, De Seze, Jérôme, Vukusic, Sandra, Marignier, Romain
• Format: Journal Article
• Language: English
• Published: United States 22.05.2018
• ISSN: 1526-632X
• DOI: 10.1212/WNL.0000000000005560

To describe clinical and radiologic features associated with myelin oligodendrocyte glycoprotein antibodies (MOG-Ab) in a large French nationwide adult cohort, to assess baseline prognostic features of MOG-Ab-associated diseases after a first acute demyelinating syndrome, and to evaluate the clinical value of MOG-Ab longitudinal analysis. Clinical data were obtained from 197 MOG-Ab-positive patients ≥18 years of age. Complete imaging data were available in 108, and 54 serum samples were eligible for longitudinal evaluation. For survival analysis comparison, 169 aquaporin-4 antibody (AQP4-Ab)-positive patients from the NOMADMUS database were included. Median age at onset was 36.46 (range 18.0-76.8) years, and patients were predominantly white (92.9%) with male:female ratio, 1.1. Clinical phenotype at onset included optic neuritis or myelitis in 90.86%, isolated brainstem or encephalopathy syndromes in 6.6%, and a combination of syndromes in 2.5%. Distinctive brain MRI findings in MOG-Ab-positive patients were thalamic and pontine lesions. Cortical and leptomeningeal lesions were found in 16.3% and 6.1%, respectively. The probability of reaching a first relapse after 2 and 5 years was 44.8% and 61.8%, respectively. MOG-Ab-positive patients were at lower risk at presentation of further clinical relapse (hazard ratio [HR] 0.45, 95% confidence interval [CI] 0.26-0.79) compared to AQP4-Ab-positive individuals. MOG-Ab-positive individuals had a lower risk of reaching Disability Status Scale score of 3.0 (HR 0.46, 95% CI 0.22-0.94) and visual acuity of 20/100 (HR 0.23, 95% CI 0.07-0.72). Finally, MOG-Ab titers were higher at relapse than in remission ( = 0.009). In adults, MOG-Ab-associated disease extends beyond clinical and radiologic abnormalities in the optic nerve and spinal cord. Despite the relapsing course, the overall visual and motor outcome is better compared with AQP4-Ab-positive patients.