MOG IgG Antibody Positivity from Laboratory to Clinical Practice: A Real World Experience
Tejas Shivarthi1, Mahima Sriram1, Muddana Nikhilesh1, Pula Rohan1, Sai Sudeep Reddy Jinna1, Sudheeran Kannoth1, Udit Saraf1, Vivek Nambiar1, Siby Gopinath1, Gopikrishnan Unnikrishnan1, Anandkumar Anandakuttan1, Annamma Mathai2, Meena Thevarkalam2, Suprabha Panicker2, Abish Sudhakar3
1Department of Neurology, 2Neuroimmunology Laboratory, Department of Neurology, 3Department of Pediatric Cardiology, Amrita School of Medicine, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham University Kochi, Kerala, India
Objective:
To investigate the clinical spectrum, diagnostic implications and treatment outcomes of laboratory positive Myelin Oligodendrocyte Glycoprotein (MOG) IgG antibody in a real-world cohort of patients.
Background:
MOG associated disease (MOGAD) is an antibody mediated inflammatory demyelinating disorder of the CNS characterized by various phenotypic presentations. There is limited data regarding the differences in clinical features, treatment outcomes and diagnostic implications between low and high strength MOG antibody positivity.
Design/Methods:
This retrospective cross-sectional study was conducted in the Neuroimmunology laboratory of a tertiary healthcare center in South Asia. Patients who tested MOG IgG positive from 2018 to 2024 using a commercial fixed cell based assay (EUROIMMUN) who received treatment from our center were included. Positive samples were categorized into low and high strength based on agreement of visual intensity of immunofluorescence between two trained observers. Clinical details were extracted from electronic medical records.
Results:
Out of 103 patients who tested positive for MOG IgG antibody, 8 had an alternate diagnosis and 95 patients were included in further analysis (Mean age: 32.47 ± 4.63 years; 53 Female; 59 Adults; 67 low strength). At least 1 core clinical demyelinating event was seen in 86/95 (90.52%) patients, the most common being optic neuritis (36/95 (37.89%)). Nine patients (9.47%) were observed to show atypical presentations of MOGAD, exclusively seen in adults (p=0.011). Children showed improved treatment response (p=0.048) but had more relapses (p=0.002).
On comparing patients with low and high strength, there was no significant difference in features, treatment outcome (p=1.000) (assessed with EDSS improvement) or relapses (p=0.243).
Conclusions:
The diagnostic value of low levels of MOG positivity is similar to that of high MOG positivity in terms of clinical features, treatment outcome and prognosis. Disease in children was associated with better treatment response and multiphasic disease, while atypical presentations were more commonly observed in the adult population.
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