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Li S, Ren H, Xu Y, Xu T, Zhang Y, Yin H, Zhang W, Li J, Ren X, Fang F, Li W, Zhu Y, Peng B, Wang J, Zhong Y, Cui L. Long-term efficacy of mycophenolate mofetil in myelin oligodendrocyte glycoprotein antibody-associated disorders: A prospective study. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2020; 7:7/3/e705. [PMID: 32170045 PMCID: PMC7136046 DOI: 10.1212/nxi.0000000000000705] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 02/05/2020] [Indexed: 11/22/2022]
Abstract
Objective To investigate whether the use of mycophenolate mofetil (MMF) could reduce the relapse risk in patients with myelin oligodendrocyte glycoprotein (MOG)-immunoglobulin G (IgG)-associated disorders (MOGADs). Methods This prospective observational cohort study included patients with MOGAD at Peking Union Medical College Hospital between January 1, 2017, and April 30, 2019. The patients were divided into 2 groups: those with (MMF+) or without (MMF−) MMF therapy. The primary outcome was relapse at follow-up. We used Cox proportional hazards models to calculate hazard ratios (HRs) for relapse. Results Seventy-nine patients were included in our MOG cohort. Fifty (63.3%) were adults at index date, and 47 (59.5%) were women. Fifty-four (68.4%) were in the MMF+ group, and 25 (31.6%) were in the MMF− group. Clinical and demographic factors, MOG-IgG titer, and follow-up time (median, 472.5 days for MMF+, 261.0 days for MMF−) were comparable between the groups. Relapse rates were 7.4% (4/54) in the MMF+ group and 44.0% (11/25) in the MMF− group. Of all potential confounders, only the use of MMF was associated with reduced risk of relapse. The HR for relapse among patients in the MMF+ group was 0.14 (95% CI, 0.05–0.45) and was 0.08 (95% CI, 0.02–0.28) in a model adjusted for age, sex, disease course, and MOG-IgG titer. MMF therapy also remained associated with a reduced relapse risk in sensitivity analyses. Only one patient (1.9%) discontinued MMF therapy because of adverse effect. Conclusions These findings provide a clinical evidence that MMF immunosuppression therapy may prevent relapse in patients with MOGAD. Classification of evidence This study provides class IV evidence that for patients with MOGAD, MMF reduces relapse risk.
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Affiliation(s)
- Shengde Li
- From the Department of Neurology (S.L., H.R., Y.X., Y. Zhang, H.Y., Y. Zhu, B.P., L.C.), Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Department of Epidemiology and Biostatistics Institute of Basic Medical Sciences (T.X.), Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College; Department of Neurology (W.Z., J.L., X.R., F.F.), Beijing Children's Hospital, Capital Medical University, National Center for Children's Health; Oumeng V Medical Laboratory (W.L.), Hangzhou; CAS Key Laboratory of Mental Health (J.W.), Institute of Psychology, Beijing, China Department of Psychology, University of Chinese Academy of Sciences; Department of Ophthalmology (Y. Zhong), Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; and Neurosciences Center (L.C.), Chinese Academy of Medical Sciences, Beijing, China
| | - Haitao Ren
- From the Department of Neurology (S.L., H.R., Y.X., Y. Zhang, H.Y., Y. Zhu, B.P., L.C.), Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Department of Epidemiology and Biostatistics Institute of Basic Medical Sciences (T.X.), Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College; Department of Neurology (W.Z., J.L., X.R., F.F.), Beijing Children's Hospital, Capital Medical University, National Center for Children's Health; Oumeng V Medical Laboratory (W.L.), Hangzhou; CAS Key Laboratory of Mental Health (J.W.), Institute of Psychology, Beijing, China Department of Psychology, University of Chinese Academy of Sciences; Department of Ophthalmology (Y. Zhong), Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; and Neurosciences Center (L.C.), Chinese Academy of Medical Sciences, Beijing, China
| | - Yan Xu
- From the Department of Neurology (S.L., H.R., Y.X., Y. Zhang, H.Y., Y. Zhu, B.P., L.C.), Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Department of Epidemiology and Biostatistics Institute of Basic Medical Sciences (T.X.), Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College; Department of Neurology (W.Z., J.L., X.R., F.F.), Beijing Children's Hospital, Capital Medical University, National Center for Children's Health; Oumeng V Medical Laboratory (W.L.), Hangzhou; CAS Key Laboratory of Mental Health (J.W.), Institute of Psychology, Beijing, China Department of Psychology, University of Chinese Academy of Sciences; Department of Ophthalmology (Y. Zhong), Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; and Neurosciences Center (L.C.), Chinese Academy of Medical Sciences, Beijing, China.
| | - Tao Xu
- From the Department of Neurology (S.L., H.R., Y.X., Y. Zhang, H.Y., Y. Zhu, B.P., L.C.), Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Department of Epidemiology and Biostatistics Institute of Basic Medical Sciences (T.X.), Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College; Department of Neurology (W.Z., J.L., X.R., F.F.), Beijing Children's Hospital, Capital Medical University, National Center for Children's Health; Oumeng V Medical Laboratory (W.L.), Hangzhou; CAS Key Laboratory of Mental Health (J.W.), Institute of Psychology, Beijing, China Department of Psychology, University of Chinese Academy of Sciences; Department of Ophthalmology (Y. Zhong), Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; and Neurosciences Center (L.C.), Chinese Academy of Medical Sciences, Beijing, China.
| | - Yao Zhang
- From the Department of Neurology (S.L., H.R., Y.X., Y. Zhang, H.Y., Y. Zhu, B.P., L.C.), Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Department of Epidemiology and Biostatistics Institute of Basic Medical Sciences (T.X.), Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College; Department of Neurology (W.Z., J.L., X.R., F.F.), Beijing Children's Hospital, Capital Medical University, National Center for Children's Health; Oumeng V Medical Laboratory (W.L.), Hangzhou; CAS Key Laboratory of Mental Health (J.W.), Institute of Psychology, Beijing, China Department of Psychology, University of Chinese Academy of Sciences; Department of Ophthalmology (Y. Zhong), Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; and Neurosciences Center (L.C.), Chinese Academy of Medical Sciences, Beijing, China
| | - Hexiang Yin
- From the Department of Neurology (S.L., H.R., Y.X., Y. Zhang, H.Y., Y. Zhu, B.P., L.C.), Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Department of Epidemiology and Biostatistics Institute of Basic Medical Sciences (T.X.), Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College; Department of Neurology (W.Z., J.L., X.R., F.F.), Beijing Children's Hospital, Capital Medical University, National Center for Children's Health; Oumeng V Medical Laboratory (W.L.), Hangzhou; CAS Key Laboratory of Mental Health (J.W.), Institute of Psychology, Beijing, China Department of Psychology, University of Chinese Academy of Sciences; Department of Ophthalmology (Y. Zhong), Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; and Neurosciences Center (L.C.), Chinese Academy of Medical Sciences, Beijing, China
| | - Weihua Zhang
- From the Department of Neurology (S.L., H.R., Y.X., Y. Zhang, H.Y., Y. Zhu, B.P., L.C.), Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Department of Epidemiology and Biostatistics Institute of Basic Medical Sciences (T.X.), Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College; Department of Neurology (W.Z., J.L., X.R., F.F.), Beijing Children's Hospital, Capital Medical University, National Center for Children's Health; Oumeng V Medical Laboratory (W.L.), Hangzhou; CAS Key Laboratory of Mental Health (J.W.), Institute of Psychology, Beijing, China Department of Psychology, University of Chinese Academy of Sciences; Department of Ophthalmology (Y. Zhong), Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; and Neurosciences Center (L.C.), Chinese Academy of Medical Sciences, Beijing, China
| | - Jiuwei Li
- From the Department of Neurology (S.L., H.R., Y.X., Y. Zhang, H.Y., Y. Zhu, B.P., L.C.), Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Department of Epidemiology and Biostatistics Institute of Basic Medical Sciences (T.X.), Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College; Department of Neurology (W.Z., J.L., X.R., F.F.), Beijing Children's Hospital, Capital Medical University, National Center for Children's Health; Oumeng V Medical Laboratory (W.L.), Hangzhou; CAS Key Laboratory of Mental Health (J.W.), Institute of Psychology, Beijing, China Department of Psychology, University of Chinese Academy of Sciences; Department of Ophthalmology (Y. Zhong), Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; and Neurosciences Center (L.C.), Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaotun Ren
- From the Department of Neurology (S.L., H.R., Y.X., Y. Zhang, H.Y., Y. Zhu, B.P., L.C.), Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Department of Epidemiology and Biostatistics Institute of Basic Medical Sciences (T.X.), Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College; Department of Neurology (W.Z., J.L., X.R., F.F.), Beijing Children's Hospital, Capital Medical University, National Center for Children's Health; Oumeng V Medical Laboratory (W.L.), Hangzhou; CAS Key Laboratory of Mental Health (J.W.), Institute of Psychology, Beijing, China Department of Psychology, University of Chinese Academy of Sciences; Department of Ophthalmology (Y. Zhong), Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; and Neurosciences Center (L.C.), Chinese Academy of Medical Sciences, Beijing, China
| | - Fang Fang
- From the Department of Neurology (S.L., H.R., Y.X., Y. Zhang, H.Y., Y. Zhu, B.P., L.C.), Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Department of Epidemiology and Biostatistics Institute of Basic Medical Sciences (T.X.), Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College; Department of Neurology (W.Z., J.L., X.R., F.F.), Beijing Children's Hospital, Capital Medical University, National Center for Children's Health; Oumeng V Medical Laboratory (W.L.), Hangzhou; CAS Key Laboratory of Mental Health (J.W.), Institute of Psychology, Beijing, China Department of Psychology, University of Chinese Academy of Sciences; Department of Ophthalmology (Y. Zhong), Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; and Neurosciences Center (L.C.), Chinese Academy of Medical Sciences, Beijing, China
| | - Wenhan Li
- From the Department of Neurology (S.L., H.R., Y.X., Y. Zhang, H.Y., Y. Zhu, B.P., L.C.), Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Department of Epidemiology and Biostatistics Institute of Basic Medical Sciences (T.X.), Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College; Department of Neurology (W.Z., J.L., X.R., F.F.), Beijing Children's Hospital, Capital Medical University, National Center for Children's Health; Oumeng V Medical Laboratory (W.L.), Hangzhou; CAS Key Laboratory of Mental Health (J.W.), Institute of Psychology, Beijing, China Department of Psychology, University of Chinese Academy of Sciences; Department of Ophthalmology (Y. Zhong), Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; and Neurosciences Center (L.C.), Chinese Academy of Medical Sciences, Beijing, China
| | - Yicheng Zhu
- From the Department of Neurology (S.L., H.R., Y.X., Y. Zhang, H.Y., Y. Zhu, B.P., L.C.), Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Department of Epidemiology and Biostatistics Institute of Basic Medical Sciences (T.X.), Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College; Department of Neurology (W.Z., J.L., X.R., F.F.), Beijing Children's Hospital, Capital Medical University, National Center for Children's Health; Oumeng V Medical Laboratory (W.L.), Hangzhou; CAS Key Laboratory of Mental Health (J.W.), Institute of Psychology, Beijing, China Department of Psychology, University of Chinese Academy of Sciences; Department of Ophthalmology (Y. Zhong), Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; and Neurosciences Center (L.C.), Chinese Academy of Medical Sciences, Beijing, China
| | - Bin Peng
- From the Department of Neurology (S.L., H.R., Y.X., Y. Zhang, H.Y., Y. Zhu, B.P., L.C.), Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Department of Epidemiology and Biostatistics Institute of Basic Medical Sciences (T.X.), Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College; Department of Neurology (W.Z., J.L., X.R., F.F.), Beijing Children's Hospital, Capital Medical University, National Center for Children's Health; Oumeng V Medical Laboratory (W.L.), Hangzhou; CAS Key Laboratory of Mental Health (J.W.), Institute of Psychology, Beijing, China Department of Psychology, University of Chinese Academy of Sciences; Department of Ophthalmology (Y. Zhong), Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; and Neurosciences Center (L.C.), Chinese Academy of Medical Sciences, Beijing, China
| | - Jing Wang
- From the Department of Neurology (S.L., H.R., Y.X., Y. Zhang, H.Y., Y. Zhu, B.P., L.C.), Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Department of Epidemiology and Biostatistics Institute of Basic Medical Sciences (T.X.), Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College; Department of Neurology (W.Z., J.L., X.R., F.F.), Beijing Children's Hospital, Capital Medical University, National Center for Children's Health; Oumeng V Medical Laboratory (W.L.), Hangzhou; CAS Key Laboratory of Mental Health (J.W.), Institute of Psychology, Beijing, China Department of Psychology, University of Chinese Academy of Sciences; Department of Ophthalmology (Y. Zhong), Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; and Neurosciences Center (L.C.), Chinese Academy of Medical Sciences, Beijing, China
| | - Yong Zhong
- From the Department of Neurology (S.L., H.R., Y.X., Y. Zhang, H.Y., Y. Zhu, B.P., L.C.), Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Department of Epidemiology and Biostatistics Institute of Basic Medical Sciences (T.X.), Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College; Department of Neurology (W.Z., J.L., X.R., F.F.), Beijing Children's Hospital, Capital Medical University, National Center for Children's Health; Oumeng V Medical Laboratory (W.L.), Hangzhou; CAS Key Laboratory of Mental Health (J.W.), Institute of Psychology, Beijing, China Department of Psychology, University of Chinese Academy of Sciences; Department of Ophthalmology (Y. Zhong), Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; and Neurosciences Center (L.C.), Chinese Academy of Medical Sciences, Beijing, China
| | - Liying Cui
- From the Department of Neurology (S.L., H.R., Y.X., Y. Zhang, H.Y., Y. Zhu, B.P., L.C.), Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Department of Epidemiology and Biostatistics Institute of Basic Medical Sciences (T.X.), Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College; Department of Neurology (W.Z., J.L., X.R., F.F.), Beijing Children's Hospital, Capital Medical University, National Center for Children's Health; Oumeng V Medical Laboratory (W.L.), Hangzhou; CAS Key Laboratory of Mental Health (J.W.), Institute of Psychology, Beijing, China Department of Psychology, University of Chinese Academy of Sciences; Department of Ophthalmology (Y. Zhong), Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; and Neurosciences Center (L.C.), Chinese Academy of Medical Sciences, Beijing, China
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