Contributions
Abstract: P1916
Type: Poster
Abstract Category: Late breaking news
Background: Antibodies to myelin-oligodendrocyte glycoprotein (MOG) have been associated with central nervous system demyelinating disorders. The phenotype of demyelinated disease associated to MOG antibodies is variable and there is limited data about the long-term outcomes.
Objective: To analyze the clinical outcomes in adult patients with MOG antibody-associated demyelinating disease.
Methods: We included 31 consecutive patients with inflammatory CNS disorders who were seropositive for MOG antibody using a live cell-based assay. Patients were followed at Hospital das Clínicas, Faculty of Medicine from University of São Paulo (São Paulo, Brazil) and all were seronegative for anti-aquaporin-4.
Results: Among the 31 patients, 20 patients had relapses and 11 had a single attack. In relapsing cases, the median disease duration was 111 (53-202) months and the median time for the second attack was 43.5 months. The median annualized relapse rate (ARR) among relapsing cases was 0.36 (range 0.1-1). Among the 11 patients with single attack, the median disease duration was 41 (range 36-66) months and 7 patients became anti-MOG negative during the follow-up. Twenty-five out of 31 (80,6%) patients had optical neuritis (ON), seven (63.6%) in the single attack group and 18 (90%) in relapsing group. The risk of further attacks was increased by every new ON episode with an odds-ratio (OR) of 6.2 (1.5-25.5). Among the patients with recurrent attacks, 19/20 (95%) patients were on long-term immunosuppression, 78,9% (15/19) were on azathioprine, 15,7% (3/19) on methotrexate (MTX), 5% (1/19) on rituximab. Treated patients had no attacks during the two years of follow up of those patients, but a single patient without immunosuppressive therapy had relapses. Out of 18/19 (94,7%) patients had no relapses with first line therapy.None of the patients with a single attack remained with immunosuppression and had no further relapses.
Conclusion: The most frequent phenotype in both (monophasic and relapsing) groups was ON. The rate of relapses in patients with MOG antibody seems to be low and well controlled with first line immunosuppressive treatment. Based on the long-term follow-up of this study, patients with a single attack may not have further attacks. Therefore, anti-MOG positive patients experiencing the first attack may require longitudinal anti-MOG titer monitoring to stratify the risk of further relapses and definition of long-term therapy.
Disclosure:
L.M. Oliveira nothing to disclose
D.K. Sato has received research support from Japan Society for the promotion of Science, CAPES/Brasil. Speaker for Biogen, Novartis, Genzyme, TEVA, Merck Serono, Roche and advisory board for Shire, Merck-Serono and Quest/Athena Diagnosis
S.L. Apóstolos-Pereira nothing to disclose
R.F. Simm nothing to disclose
F.M.H. Jorge nothing to disclose
D. Callegaro speaker grants from Biogen and Sanofi-Aventis
Abstract: P1916
Type: Poster
Abstract Category: Late breaking news
Background: Antibodies to myelin-oligodendrocyte glycoprotein (MOG) have been associated with central nervous system demyelinating disorders. The phenotype of demyelinated disease associated to MOG antibodies is variable and there is limited data about the long-term outcomes.
Objective: To analyze the clinical outcomes in adult patients with MOG antibody-associated demyelinating disease.
Methods: We included 31 consecutive patients with inflammatory CNS disorders who were seropositive for MOG antibody using a live cell-based assay. Patients were followed at Hospital das Clínicas, Faculty of Medicine from University of São Paulo (São Paulo, Brazil) and all were seronegative for anti-aquaporin-4.
Results: Among the 31 patients, 20 patients had relapses and 11 had a single attack. In relapsing cases, the median disease duration was 111 (53-202) months and the median time for the second attack was 43.5 months. The median annualized relapse rate (ARR) among relapsing cases was 0.36 (range 0.1-1). Among the 11 patients with single attack, the median disease duration was 41 (range 36-66) months and 7 patients became anti-MOG negative during the follow-up. Twenty-five out of 31 (80,6%) patients had optical neuritis (ON), seven (63.6%) in the single attack group and 18 (90%) in relapsing group. The risk of further attacks was increased by every new ON episode with an odds-ratio (OR) of 6.2 (1.5-25.5). Among the patients with recurrent attacks, 19/20 (95%) patients were on long-term immunosuppression, 78,9% (15/19) were on azathioprine, 15,7% (3/19) on methotrexate (MTX), 5% (1/19) on rituximab. Treated patients had no attacks during the two years of follow up of those patients, but a single patient without immunosuppressive therapy had relapses. Out of 18/19 (94,7%) patients had no relapses with first line therapy.None of the patients with a single attack remained with immunosuppression and had no further relapses.
Conclusion: The most frequent phenotype in both (monophasic and relapsing) groups was ON. The rate of relapses in patients with MOG antibody seems to be low and well controlled with first line immunosuppressive treatment. Based on the long-term follow-up of this study, patients with a single attack may not have further attacks. Therefore, anti-MOG positive patients experiencing the first attack may require longitudinal anti-MOG titer monitoring to stratify the risk of further relapses and definition of long-term therapy.
Disclosure:
L.M. Oliveira nothing to disclose
D.K. Sato has received research support from Japan Society for the promotion of Science, CAPES/Brasil. Speaker for Biogen, Novartis, Genzyme, TEVA, Merck Serono, Roche and advisory board for Shire, Merck-Serono and Quest/Athena Diagnosis
S.L. Apóstolos-Pereira nothing to disclose
R.F. Simm nothing to disclose
F.M.H. Jorge nothing to disclose
D. Callegaro speaker grants from Biogen and Sanofi-Aventis