Multiple types of relapses in MOG antibody disease

MULTIPLE SCLEROSIS AND RELATED DISORDERS(2023)

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Myelin oligodendrocyte glycoprotein antibody disease (MOGAD) is a relatively newly recognized entity among the autoimmune diseases of the central nervous system (CNS), defined as an inflammatory demyelinating attack in the context of circulating MOG antibodies ( Banwell et al., 2023 Banwell B. Bennett J.L. Marignier R. Kim H.J. Brilot F. Flanagan E.P. Ramanathan S. Waters P. Tenembaum S. Graves J.S. Chitnis T. Brandt A.U. Hemingway C. Neuteboom R. Pandit L. Reindl M. Saiz A. Sato D.K. Rostasy K. Paul F. Pittock S.J. Fujihara K. Palace J. Diagnosis of myelin oligodendrocyte glycoprotein antibody-associated disease: international MOGAD Panel proposed criteria. Lancet Neurol. 2023; 0https://doi.org/10.1016/S1474-4422(22)00431-8 Abstract Full Text Full Text PDF Scopus (16) Google Scholar ). Relapsing MOGAD occurs in ∼50% of cases ( Armangue et al., 2020 Armangue T. Olivé-Cirera G. Martínez-Hernandez E. Sepulveda M. Ruiz-Garcia R. Muñoz-Batista M. Ariño H. González-Álvarez V. Felipe-Rucián A. Jesús Martínez-González M. Cantarín-Extremera V. Concepción Miranda-Herrero M. Monge-Galindo L. Tomás-Vila M. Miravet E. Málaga I. Arrambide G. Auger C. Tintoré M. Montalban X. Vanderver A. Graus F. Saiz A. Dalmau J. Spanish Pediatric anti-MOG Study GroupAssociations of paediatric demyelinating and encephalitic syndromes with myelin oligodendrocyte glycoprotein antibodies: a multicentre observational study. Lancet Neurol. 2020; 19: 234-246https://doi.org/10.1016/S1474-4422(19)30488-0 Abstract Full Text Full Text PDF PubMed Scopus (129) Google Scholar ; Cobo-Calvo et al., 2018 Cobo-Calvo A. Ruiz A. Maillart E. Audoin B. Zephir H. Bourre B. Ciron J. Collongues N. Brassat D. Cotton F. Papeix C. Durand-Dubief F. Laplaud D. Deschamps R. Cohen M. Biotti D. Ayrignac X. Tilikete C. Thouvenot E. Brochet B. Dulau C. Moreau T. Tourbah A. Lebranchu P. Michel L. Lebrun-Frenay C. Montcuquet A. Mathey G. Debouverie M. Pelletier J. Labauge P. Derache N. Coustans M. Rollot F. De Seze J. Vukusic S. Marignier R. OFSEP and NOMADMUS Study GroupClinical spectrum and prognostic value of CNS MOG autoimmunity in adults: the MOGADOR study. Neurology. 2018; 90: e1858-e1869https://doi.org/10.1212/WNL.0000000000005560 Crossref PubMed Scopus (321) Google Scholar ; Jurynczyk et al., 2017 Jurynczyk M. Messina S. Woodhall M.R. Raza N. Everett R. Roca-Fernandez A. Tackley G. Hamid S. Sheard A. Reynolds G. Chandratre S. Hemingway C. Jacob A. Vincent A. Leite M.I. Waters P. Palace J. Clinical presentation and prognosis in MOG-antibody disease: a UK study. Brain. 2017; 140: 3128-3138https://doi.org/10.1093/brain/awx276 Crossref PubMed Scopus (402) Google Scholar ; Waters et al., 2020 Waters P. Fadda G. Woodhall M. O'Mahony J. Brown R.A. Castro D.A. Longoni G. Irani S.R. Sun B. Yeh E.A. Marrie R.A. Arnold D.L. Banwell B. Bar-Or A. Canadian Pediatric Demyelinating Disease NetworkSerial anti-myelin oligodendrocyte glycoprotein antibody analyses and outcomes in children with demyelinating syndromes. JAMA Neurol. 2020; 77: 82-93https://doi.org/10.1001/jamaneurol.2019.2940 Crossref PubMed Scopus (127) Google Scholar ) but varying definitions of what constitutes a relapse can affect the estimate. In related conditions such as multiple sclerosis and neuromyelitis optica spectrum disorder (NMOSD), a relapse is typically defined as new or worsening neurological symptoms that last for at least 24 hours and are not due to other factors such as infection or medication side effects ( Cree et al., 2019 Cree B.A.C. Bennett J.L. Kim H.J. Weinshenker B.G. Pittock S.J. Wingerchuk D.M. Fujihara K. Paul F. Cutter G.R. Marignier R. Green A.J. Aktas O. Hartung H.-.P. Lublin F.D. Drappa J. Barron G. Madani S. Ratchford J.N. She D. Cimbora D. Katz E. Inebilizumab for the treatment of neuromyelitis optica spectrum disorder (N-MOmentum): a double-blind, randomised placebo-controlled phase 2/3 trial. Lancet North Am. Ed. 2019; 394: 1352-1363https://doi.org/10.1016/S0140-6736(19)31817-3 Abstract Full Text Full Text PDF PubMed Scopus (321) Google Scholar ; Inusah et al., 2010 Inusah S. Sormani M.P. Cofield S.S. Aban I.B. Musani S.K. Srinivasasainagendra V. Cutter G.R. Assessing changes in relapse rates in multiple sclerosis. Mult. Scler. 2010; 16: 1414-1421https://doi.org/10.1177/1352458510379246 Crossref PubMed Scopus (85) Google Scholar ; Pittock et al., 2019 Pittock S.J. Berthele A. Fujihara K. Kim H.J. Levy M. Palace J. Nakashima I. Terzi M. Totolyan N. Viswanathan S. Wang K.-.C. Pace A. Fujita K.P. Armstrong R. Wingerchuk D.M. Eculizumab in aquaporin-4–positive neuromyelitis optica spectrum disorder. N. Engl. J. Med. 2019; 381: 614-625https://doi.org/10.1056/NEJMoa1900866 Crossref PubMed Scopus (394) Google Scholar ; Yamamura et al., 2019 Yamamura T. Kleiter I. Fujihara K. Palace J. Greenberg B. Zakrzewska-Pniewska B. Patti F. Tsai C.-.P. Saiz A. Yamazaki H. Kawata Y. Wright P. De Seze J. Trial of satralizumab in neuromyelitis optica spectrum disorder. N. Engl. J. Med. 2019; 381: 2114-2124https://doi.org/10.1056/NEJMoa1901747 Crossref PubMed Scopus (285) Google Scholar ). Attacks also need to be separated from the prior relapse by at least 30 days. The presence of new or active lesions on MRI may provide supportive evidence for diagnosing a relapse, but is not necessary. In MOGAD, there are three additional issues that need to be considered to develop a useful definition of relapse: clustered inflammatory events within the 30-day period, steroid withdrawal-triggered events, and variable timing of the MRI.
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mog antibody disease,relapses
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