Volume 94, Issue 3 pp. 508-517
Research Article

Do Early Relapses Predict the Risk of Long-Term Relapsing Disease in an Adult and Paediatric Cohort with MOGAD?

Bo Chen MD

Bo Chen MD

Nuffield Department of Clinical Neurosciences, Oxford University Hospitals, Oxford, UK

Department of Neurology, Tongji Hospital of Tongji Medical College, Huazhong University of Science of Technology, Wuhan, China

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Enrique Gomez-Figueroa MD

Enrique Gomez-Figueroa MD

Nuffield Department of Clinical Neurosciences, Oxford University Hospitals, Oxford, UK

Department of Neurology, Civil Hospital of Guadalajara, University of Guadalajara, Guadalajara, Mexico

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Vyanka Redenbaugh MD

Vyanka Redenbaugh MD

Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN

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Anna Francis BMBCh

Anna Francis BMBCh

Nuffield Department of Clinical Neurosciences, Oxford University Hospitals, Oxford, UK

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Chanjira Satukijchai MD

Chanjira Satukijchai MD

Neuroscience Centre, Bangkok International Hospital, Bangkok, Thailand

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Yan Wu MD

Yan Wu MD

Department of Neurology, First Affiliated Hospital of Kunming Medical University, Kunming, China

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Silvia Messina MD

Silvia Messina MD

Nuffield Department of Clinical Neurosciences, Oxford University Hospitals, Oxford, UK

Neurology Department, Wexham Park Hospital, Frimley Foundation Health Trust, Slough, UK

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Mario Sa MD

Mario Sa MD

Department of Paediatric Neurology, Oxford University NHS Foundation Trust, Oxford, UK

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Mark Woodhall PhD

Mark Woodhall PhD

Oxford Autoimmune Neurology Diagnostic Laboratory, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK

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Friedemann Paul MD

Friedemann Paul MD

Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité Universitaetsmedizin Berlin, Germany

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Neil P. Robertson MD

Neil P. Robertson MD

Department of Neurology, Division of Psychological Medicine and Clinical Neuroscience, Cardiff University, University Hospital of Wales, Cardiff, UK

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Ming Lim MD, PhD

Ming Lim MD, PhD

Children's Neuroscience Centre, Evelina London Children's Hospital, London, UK

Women and Children's Department, Faculty of Life Sciences and Medicine, King's College London, London, UK

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Evangeline Wassmer MD

Evangeline Wassmer MD

Department of Paediatric Neurology, Birmingham Women and Children's Hospital, Birmingham, UK

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Rachel Kneen MD

Rachel Kneen MD

Department of Paediatric Neurology, Alder Hey Children's NHS Foundation Trust and Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK

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Saif Huda MD, DPhil

Saif Huda MD, DPhil

Department of Neurology, Walton Centre NHS Foundation Trust, Liverpool, UK

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Camilla Blain MD

Camilla Blain MD

Department of Neurology, St. George's University Hospitals National Health Service Foundation Trust, London, UK

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Christopher Halfpenny PhD

Christopher Halfpenny PhD

Department of Neurology, Southampton General Hospital, Southampton, UK

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Cheryl Hemingway MD

Cheryl Hemingway MD

Department of Paediatric Neurology, Great Ormond St. Hospital for Children, London, UK

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Eoin O'Sullivan MD

Eoin O'Sullivan MD

Department of Ophthalmology, King's College Hospital NHS Foundation Trust, London, UK

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Jeremy Hobart MD

Jeremy Hobart MD

Department of Neurology, University Hospitals Plymouth National Health Service Foundation Trust, Devon, UK

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Leonora K. Fisniku PhD

Leonora K. Fisniku PhD

Department of Neurosciences, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK

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Roswell J. Martin MD

Roswell J. Martin MD

Department of Neurology, Gloucestershire Hospitals National Health Service Foundation Trust, Gloucestershire, UK

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Ruth Dobson MD

Ruth Dobson MD

Preventive Neurology Unit, Queen Mary University London, London, UK

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Sarah A. Cooper MD

Sarah A. Cooper MD

Department of Neurology, University Hospitals Sussex National Health Service Foundation Trust, Brighton, UK

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Victoria Williams MD

Victoria Williams MD

Department of Neurology, King's College Hospital NHS Foundation Trust, London, UK

Department of Neurology, Guy's and St. Thomas' National Health Service Foundation Trust, London, UK

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Patrick Waters PhD

Patrick Waters PhD

Oxford Autoimmune Neurology Diagnostic Laboratory, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK

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John J. Chen MD, PhD

John J. Chen MD, PhD

Department of Ophthalmology and Neurology, Mayo Clinic, Rochester, MN

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Sean J. Pittock MD

Sean J. Pittock MD

Centre MS and Autoimmune Neurology, Department Neurology, Mayo Clinic, Rochester, MN

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Sithara Ramdas MD

Sithara Ramdas MD

MDUK Neuromuscular Centre, Department of Paediatrics, University of Oxford, Oxford, UK

Department of Paediatric Neurology, John Radcliffe Hospital, Oxford, UK

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Maria Isabel Leite MD, PhD

Maria Isabel Leite MD, PhD

Nuffield Department of Clinical Neurosciences, Oxford University Hospitals, Oxford, UK

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Eoin P. Flanagan MD

Eoin P. Flanagan MD

Departments of Neurology & Laboratory Medicine and Pathology and Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN

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Ruth Geraldes MD

Ruth Geraldes MD

Nuffield Department of Clinical Neurosciences, Oxford University Hospitals, Oxford, UK

Neurology Department, Wexham Park Hospital, Frimley Foundation Health Trust, Slough, UK

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Jacqueline Palace MD

Corresponding Author

Jacqueline Palace MD

Nuffield Department of Clinical Neurosciences, Oxford University Hospitals, Oxford, UK

Address correspondence to Dr Palace, Department of Clinical Neurology, John Radcliffe Hospital, Oxford, OX3 9DU, UK. E-mail: [email protected]

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First published: 03 July 2023
Citations: 2

Enrique Gomez-Figueroa, Vyanka Redenbaugh, Anna Francis, Eoin P. Flanagan and Ruth Geraldes contributed equally to this work.

[Correction added on January 3, 2024, after first online publication: Friedemann Paul was added to the author list.]

Abstract

Objective

Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) can be monophasic or relapsing, with early relapse being a feature. However, the relevance of early relapse on longer-term relapse risk is unknown. Here, we investigate whether early relapses increase longer-term relapse risk in patients with MOGAD.

Methods

A retrospective analysis of 289 adult- and pediatric-onset patients with MOGAD followed for at least 2 years in 6 specialized referral centers. “Early relapses” were defined as attacks within the first 12 months from onset, with “very early relapses” defined within 30 to 90 days from onset and “delayed early relapses” defined within 90 to 365 days. “Long-term relapses” were defined as relapses beyond 12 months. Cox regression modeling and Kaplan–Meier survival analysis were used to estimate the long-term relapse risk and rate.

Results

Sixty-seven patients (23.2%) had early relapses with a median number of 1 event. Univariate analysis revealed an elevated risk for long-term relapses if any “early relapses” were present (hazard ratio [HR] = 2.11, p < 0.001), whether occurring during the first 3 months (HR = 2.70, p < 0.001) or the remaining 9 months (HR = 1.88, p = 0.001), with similar results yielded in the multivariate analysis. In children with onset below aged 12 years, only delayed early relapses were associated with an increased risk of long-term relapses (HR = 2.64, p = 0.026).

Interpretation

The presence of very early relapses and delayed early relapses within 12 months of onset in patients with MOGAD increases the risk of long-term relapsing disease, whereas a relapse within 90 days appears not to indicate a chronic inflammatory process in young pediatric-onset disease. ANN NEUROL 2023;94:508–517

Potential Conflicts of Interest

None relevant to this work.

Data Availability Statement

The data herein are unavailable publicly due to restricted access, but some information about the data sets is available from the corresponding author upon reasonable request.

The full text of this article hosted at iucr.org is unavailable due to technical difficulties.

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