To assess age-dependent risk factors associated with relapses in patients with Myelin Oligodendrocyte Glycoprotein Antibody Disease (MOGAD).
Patients with MOGAD exhibit significant heterogeneity in clinical presentation and treatment responses. However, the impact of patient age on the disease course remains unclear.
We conducted a retrospective cohort analysis using our clinical database comprising MOGAD cases followed at the Mass General Brigham system in Boston. The primary outcome was relapses. Cox-proportional mixed-effect models were used to calculate hazard ratios (HRs) for multiple relapses.
A total of 256 patients were included in the study. Multivariate Cox regression analysis showed that, compared to patients aged 30-45, patients aged 45 years or older and patients aged less than 30 years exhibited a higher risk of relapses. The change in HR across all ages revealed a U-shaped risk curve, indicating that patients at both ends of the age spectrum are more susceptible to relapses. When compared to no treatment, IVIG (intravenous immunoglobulin) consistently showed a lower relative risk of relapses across all age groups. In contrast, rituximab demonstrated a down-trending relative risk with increasing age, and the model estimate indicated that reduced risk of relapses with rituximab was only observed in patients older than approximately 30 years. Subgroup analysis revealed that in younger patients, cerebral syndrome was linked to a lower risk of relapses. Conversely, in older patients, optic neuritis were associated with a higher risk of relapses.
Our findings underscore the importance of considering age-related factors in MOGAD management. While rituximab is one of the mainstays in maintenance therapy, it appears to confer a protective effect primarily in older patients in our cohort. In contrast, IVIG is consistently associated with favorable outcomes across all ages. These insights can guide personalized treatment strategies for patients with MOGAD.