Early Maintenance Treatment Initiation and Relapse Risk Mitigation After a First Event of MOGAD in Adults: The MOGADOR2 Study.
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Deschamps Romain, Guillaume Jessica, Ciron Jonathan, Audoin Bertrand, Ruet Aurélie, Maillart Elisabeth, Pique Julie, Benyahya Lakhdar, Laplaud David A, Michel Laure, Collongues Nicolas, Cohen Mikael, Ayrignac Xavier, Thouvenot Eric, Zephir Helene, Bourre Bertrand, Froment Tilikete Caroline, Moreau Thibault, Cantagrel Paul, Kerschen Philippe, Cabasson Sebastien, Maubeuge Nicolas, Hankiewicz Karolina, Nifle Chantal, Berger Eric, Megherbi Hana, Magy Laurent, Klapczynski Frederic, Sarov Riviere Mariana, Giannesini Claire, Hamelin Lorraine, Giroux Marianne, Branger Pierre, Maurousset Aude, Mathey Guillaume, Moulin Maximilien, Mélé Nicolas, Papeix Caroline, Marignier Romain, as the NOMADMUS study group
Аннотация
METHODS: Clinical and biological data were obtained from patients with a first event of MOGAD and included in the French nationwide incident cohort between February 2014 and March 2017. Only patients aged 18 years or older at disease onset and with observation period of at least 3 months were included. Data were collected prospectively until July 2023 and registered in the dedicated French nationwide database. This form includes every relapse with phenotype description during follow-up, date of last assessment, final clinical outcome with Expanded Disability Status Scale score and visual acuity, and maintenance therapy. The probability of recurrence-free survival was assessed using the Kaplan-Meier method.
RESULTS: We included 128 patients. The onset phenotype was isolated optic neuritis in 81 patients (63.3%) and isolated myelitis in 25 patients (19.5%). The median follow-up duration was 77.8 months (range 3.2-111.2), with 49 patients (38.3%) experienced at least one relapse. Median times from onset to second and third attacks were 3.2 (1.0-86.2) and 13.0 (2.6-64.4) months, respectively. At the last assessment, Expanded Disability Status Scale Score was ≥3 and ≥6 in 22 (17.2%) and 6 (4.7%) patients, respectively. Eighty patients received at least one maintenance treatment. This treatment was initiated after the first attack in 47 patients (36.7% of the whole cohort) and at the time of a second attack in 25 (19.5%). Multivariate analysis revealed that initiating maintenance treatment after the first attack was associated with a lower relapse risk (OR = 0.26 [95% CI 0.11-0.62], p = 0.002). In patients receiving maintenance therapy after first attack, the 2-year, 4-year, 6-year, and 8-year relapse risks were 11%, 15%, 20%, and 20%, respectively. In other patients, the risks were 41%, 46%, 51%, and 56%.
DISCUSSION: The highest risk of a relapse in MOGAD occurs early, and initiating maintenance therapy from the first attack substantially reduced the relapse risk.
CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that initiating maintenance therapy from the first attack in patients with MOGAD reduces the relapse risk.