This was an international retrospective, multicenter, cohort study conducted from January 1, 2010, to October 31, 2021, of patients with MOGAD who received maintenance IVIG therapy. 10, 11, 15 To better understand the association of IVIG therapy with the prevention of recurrent attacks in adults, we evaluated a large international multicenter cohort of adult patients with MOGAD who received maintenance IVIG. 10, 12, 14 There are very few studies evaluating maintenance IVIG in adults with MOGAD. 9 - 13 Some recent observational studies suggest that maintenance intravenous immunoglobulin (IVIG) may be an effective treatment in preventing relapse in MOGAD, but these studies were predominantly performed in children. Several traditional treatments used for multiple sclerosis have not been found to be effective for MOGAD, 9 - 11 and treatments used for neuromyelitis optica spectrum disorder, such as rituximab, have varying efficacy in retrospective studies. 1, 4, 8 To our knowledge, there is currently no approved therapy to reduce the relapse frequency in MOGAD. 1, 4 - 8 A significant fraction of patients with MOGAD will experience recurrent demyelinating attacks, most frequently ON. 1 - 3 The clinical phenotype can include optic neuritis (ON), transverse myelitis (TM), acute disseminating encephalomyelitis (ADEM), and other manifestations. Myelin oligodendrocyte glycoprotein antibody–associated disease (MOGAD) is a distinct central nervous system (CNS) demyelinating disease that can relapse and has the potential to cause severe morbidity. Future prospective randomized clinical trials are warranted to confirm these findings. Less frequent and lower dosing of IVIG may be associated with treatment failure.
Mog ad trial#
Seven of 59 patients (12%) discontinued IVIG therapy: 4 (57%) for inefficacy, 2 (29%) for adverse effects, and 1 (14%) for a trial not receiving therapy after a period of disease inactivity.Ĭonclusions and Relevance Results of this retrospective, multicenter, cohort study of adult patients with MOGAD suggest that maintenance IVIG was associated with a reduction in disease relapse. At final follow-up, 52 patients (88%) were still receiving maintenance IVIG with a median (range) duration of 1.7 (0.5-9.9) years of therapy. Only 5 of 29 patients (17%) who received 1 g/kg of IVIG every 4 weeks or more experienced disease relapse compared with 15 of 30 patients (50%) treated with lower or less frequent dosing (hazard ratio, 3.31 95% CI, 1.19-9.09 P = .02). Twenty patients (34%) had at least 1 relapse while receiving IVIG with a median (range) time to first relapse of 1 (0.03-4.8) years, and 17 patients (29%) were treated with concomitant maintenance immunotherapy. The median (range) annualized relapse rate before IVIG treatment was 1.4 (0-6.1), compared with a median (range) annualized relapse rate while receiving IVIG of 0 (0-3) ( t 108 = 7.14 P < .001). IVIG was initiated as first-line immunotherapy in 15 patients (25%) and as second-line therapy in 37 patients (63%) owing to failure of prior immunotherapy and in 7 patients (12%) owing to intolerance to prior immunotherapy. Results Of the 876 adult patients initially identified with MOGAD, 59 (median age, 36 years 33 women ) were treated with maintenance IVIG. Main Outcomes and Measures Relapse rates while receiving maintenance IVIG compared with before initiation of therapy. These patients were retrospectively evaluated for a history of maintenance IVIG treatment. Patients were recruited from 14 hospitals in 9 countries and were included in the analysis if they (1) had a history of 1 or more central nervous system demyelinating attacks consistent with MOGAD, (2) had MOG-IgG seropositivity tested by cell-based assay, and (3) were age 18 years or older when starting IVIG treatment.
Objective To determine the association of maintenance IVIG with the prevention of disease relapse in a large adult cohort of patients with MOGAD.ĭesign, Setting, and Participants This was a retrospective cohort study conducted from January 1, 2010, to October 31, 2021. Importance Recent studies suggest that maintenance intravenous immunoglobulin (IVIG) may be an effective treatment to prevent relapses in myelin oligodendrocyte glycoprotein antibody–associated disease (MOGAD) however, most of these studies had pediatric cohorts, and few studies have evaluated IVIG in adult patients. Shared Decision Making and Communication.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography.
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