Identification of risk factors for relapse at initial onset in myelin oligodendrocyte glycoprotein antibody-associated optic neuritis using ophthalmic findings.

PURPOSE: To identify risk factors for relapse in patients with myelin oligodendrocyte glycoprotein antibody-associated optic neuritis (MOG-ON) during the onset event.

STUDY

DESIGN

Retrospective cohort study.

METHODS

We included 44 eyes of 44 Japanese patients with MOG-ON (median age 40.0 years [interquartile range 23.5-54.0]; male to female ratio 16:28) who visited Tohoku University Hospital between August 2013 and December 2024. We compared patient background characteristics; ophthalmic findings, including optical coherence tomography parameters; laboratory findings, including hematological, biochemical, and immunological parameters; anti-MOG antibody titers; and contrast-enhanced orbital MRI findings at baseline in relapse and non-relapse groups. Relapse risk was evaluated using a Kaplan-Meier survival analysis and a Cox proportional hazards regression.

RESULTS

Nine of 44 (20.5%) patients relapsed during follow-up. The Kaplan-Meier analysis showed lower relapse-free survival in patients without eye-movement pain, those with a lower serum IgG level, and those with a thinner macular retinal nerve fiber layer (mRNFL; log-rank P=0.013, 0.049, and 0.040, respectively). In the age- and sex-adjusted Cox proportional hazards analysis, relapse risk was significantly associated with absence of eye-movement pain (hazard ratio [HR] 5.58, 95% confidence interval [CI] 1.35-23.04; P=0.018), a lower serum IgG level (HR 0.55, 95% CI 0.30-1.00; P=0.048), and a higher anti-MOG antibody titer (HR 1.98, 95% CI 1.05-3.71; P=0.034).

CONCLUSION

Baseline absence of eye-movement pain, lower serum IgG level, and higher anti-MOG antibody titer were associated with relapse risk in patients with MOG-ON. A thinner mRNFL may represent a potential marker of relapse-related outcomes.