French NOMADMUS Cohort Overview: Landscape Evolution of AQP4+NMOSD and MOGAD From 2010 to 2024.

OBJECTIVES

Aquaporin 4-immunoglobulin G-seropositive neuromyelitis optica spectrum disorder (AQP4+NMOSD) and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) are rare conditions with evolving diagnostic and therapeutic approaches. Our study aims to describe these evolutions in France, using data from the NOMADMUS cohort.

METHODS

We retrospectively analyzed clinical, imaging, and therapeutic data collected across 98 French centers as of June 8, 2024. Patients were classified based on serologic status into AQP4+NMOSD or MOGAD.

RESULTS

The cohort included 769 AQP4+NMOSD and 957 patients with MOGAD, 68.6% female with a mean age at onset of 37.4 years (18.3). The mean annualized relapse rates decreased from 2010-2014 to 2022-2023 in both groups (for example, from 0.45 (0.41-0.48) to 0.04 (0.03-0.05) in AQP4+NMOSD, Welch's t tests, p < 0.0001). Rituximab use increased in AQP4+NMOSD patients over time and was associated with a lower risk to reach Expanded Disability Status Scale (EDSS) 6 (HR 0.38; p < 0.001, 0.21-0.68). Risk to reach EDSS 3 or 6 was lower in patients with MOGAD compared with AQP4+NMOSD patients.

DISCUSSION: This nationwide registry revealed a reduction of the time to diagnosis, a decreased disease activity over time, and an evolution in the therapeutic strategies these past 15 years. This collaborative effort provides valuable insights into current knowledge about clinical practice and treatment patterns in real-world settings.