MOGAD Clinical Characteristics, Treatments, and Outcomes in Singapore: A Nationwide Observational Cohort Study
Xin Yang1, Abu Shakran Bin Mahmood2, Seyed Ehsan Saffari3, Jeanne May May Tan4, Kevin Tan4, Amy May Lin Quek5, Yihui Goh5, Derek Soon5, Terrence Thomas6, Simon Ling6, Yong Kok Pin7, Sarah Hasnor Binti Abu Hassan7, Shweta Singhal8, Reuben Chao Ming Foo8, Oliver Zheng Hui Mah8, Su Ann Lim9, Chee Fang Chin9, Kelvin Zhenghao Li9, Velda Han6, Furene Wang6, Hian Tat Ong6, Tianrong Yeo10
1Medicine, Ministry of Health Holdings (MOHH), 2Lee Kong Chian School of Medicine, 3Duke-NUS Medical School, 4Department of Neurology, National Neuroscience Institute, NNI (TTSH campus), 5Department of Neurology, National University Hospital Singapore (NUHS), 6Department of Paediatrics, KK Women's and Children's Hospital (KKH), 7Department of Neurology, National Neuroscience Institute, NNI (SGH campus), 8Singapore National Eye Centre (SNEC), 9Department of Ophthalmology, Tan Tock Seng Hospital (TTSH), 10Duke-NUS Medical School;National Neuroscience Institute, NNI (TTSH campus)
Objective:
We investigated clinical features, long-term sequelae of MOGAD (myelin oligodendrocyte glycoprotein antibody-associated disease) patients in Singapore and examined factors associated with relapses and unfavorable neurological outcomes.
Background:
MOGAD is a inflammatory demyelinating disease of the central nervous system. In Singapore, a multi-ethnic Southeast Asian population, its clinical phenotypes and optimal treatment strategies are still poorly defined.
Design/Methods:
This retrospective cohort study involved all public healthcare institutions in Singapore, including patients with a first attack before January 2024. All patients had at least one inflammatory attack consistent with MOGAD, with positive MOG antibodies on cell-based assays. Clinical, investigational, treatment, outcome data (visual acuity [VA] and Expanded Disability Status Scale [EDSS]) were collected. Relapse-free survival was estimated using Kaplan-Meier method. Predictors of relapse and poor functional outcomes were assessed using Cox proportional hazards model and logistic regression.
Results:
130 patients were included (107 adult, 23 pediatric cases). The median follow-up duration was 21.3 months (IQR 8.4–52.4 months). Median age of onset was 34 years (range 3–80). Optic neuritis (ON) was the most common onset phenotype (61.5%), followed by transverse myelitis (11.5%) and cerebral cortical encephalitis (CCE) (8.5%). Pediatric patients presented more commonly with acute disseminated encephalomyelitis or CCE than adults (52.2% vs 10.2%, p<0.0001). 45 patients (34.6%) relapsed, with median time of 5.9 months (range 0.7–160.3) to first relapse. At last follow-up, severe (VA≤0.1) and moderate (≤0.7) visual loss occurred in 1 (1.1%) and 23 (25.3%) patients with ON respectively, while EDSS ≥6 occurred in 6.4% of non-ON phenotypes. Patients receiving ≥3 months of maintenance immunosuppression after first attack had a significantly lower relapse risk than those given shorter or no treatment (log-rank test, p=0.029).
Conclusions:
Our findings highlight that (1) neurological prognosis is generally favorable in MOGAD, (2) relapse risk is greatest shortly after sentinel attack, (3) maintenance treatment ≥3 months significantly reduced relapse risk.
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