Radiologic Disease Activity Independent of Relapses in Aquaporin4-IgG-Seropositive Neuromyelitis Optica Spectrum Disorder (AQP4-IgG+ NMOSD), Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease (MOGAD), and Multiple Sclerosis (MS): A Retrospective Comparative Study
Negar Molazadeh1, Gauruv Bose2, Tanuja Chitnis3, Michael Levy1
1Massachusetts General Hospital and Harvard Medical School, 2Brigham MS Center, Mass General Brigham, Harvard Medical School and Division of Neurology, Department of Medicine, The Ottawa Hospital and University of Ottawa; Ottawa Hospital Research Institute, ON, Canada, 3Brigham and Women's Hospital
Objective:
To investigate radiologic disease activity independent of relapses in patients with AQP4-IgG+NMOSD, MOGAD, and MS.
Background:
Relapse-independent radiologic disease activity is not well established in AQP4-IgG+NMOSD and MOGAD.
Design/Methods:
This is a retrospective chart review study of AQP4-IgG+NMOSD and MOGAD patients from the neuroimmunology clinic of Massachusetts General Hospital, and equivalent MS controls matched for age, sex, and disease duration from the CLIMB study, Brigham and Women’s Hospital. All patients fulfilled the latest diagnostic criteria for each disease and had positive AQP4-IgG and MOG-IgG being tested by cell-based assays. We reviewed the MRI reports of the brain and spinal cord for new T2 lesions, new enhancing lesions, and persistent enhancement during relapse-free periods.
Results:
We included 49 AQP4-IgG+NMOSD (89.9% female, mean follow-up (SD) of 43.5(19.0) months), 36 MOGAD (63.9% female, mean follow-up (SD) of 29.6(11.6) months), and equivalent 49 and 36 matched MS controls for each group. New T2 lesions in the brain MRI were seen in 6/49 (12.24%) AQP4-IgG+NMOSD and 20/49 (40.81%) MS controls (P value=0.001), as well as 1/36 (2.77%) MOGAD and 12/36 (33.33%) MS controls (P value= 0.001). New enhancing lesions in the brain MRI of AQP4-IgG+NMOSD and MS controls were seen in 1/49 (2.04%) and 14/49 (28.57%) (P value=0.000), as well as in 0/36 (0%) MOGAD and 13/36 (36.11%) MS controls (P=0.003). New T2 lesions in the spinal cord MRI were seen in 1/49 (2.04%) AQP4-IgG+NMOSD and 16/49 (32.65%) MS controls (P value=0.000), as well as 2/36 (5.55%) MOGAD and 11/36 (30.55%) MS controls (P value=0.006). Persistent enhancement was seen in brain and spinal cord MRIs of neither AQP4-IgG+NMOSD nor MOGAD patients but in 7/85 MS controls.
Conclusions:
Relapse-independent new T2 or enhancing lesions in the brain and spinal cord are not common in AQP4-IgG+NMOSD and MOGAD patients, compared to MS.