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Satukijchai C, Mariano R, Messina S, Sa M, Woodhall MR, Robertson NP, Ming L, Wassmer E, Kneen R, Huda S, Jacob A, Blain C, Halfpenny C, Hemingway C, O'Sullivan E, Hobart J, Fisniku LK, Martin R, Dopson R, Cooper SA, Williams V, Waters PJ, Ramdas S, Leite MI, Palace J. Factors Associated With Relapse and Treatment of Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease in the United Kingdom. JAMA Netw Open 2022; 5:e2142780. [PMID: 35006246 PMCID: PMC8749481 DOI: 10.1001/jamanetworkopen.2021.42780] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
IMPORTANCE Longer-term outcomes and risk factors associated with myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) are not well established. OBJECTIVE To investigate longer-term risk of relapse and factors associated with this risk among patients with MOGAD. DESIGN, SETTING, AND PARTICIPANTS This large, single-nation, prospective cohort study was conducted among 276 patients with MOGAD at 5 health care centers in the UK. Data from January 1973 to March 2020 were collected from 146 patients at Oxford and its outreach sites, 65 patients at Liverpool, 32 patients at a children's hospital in Birmingham, 22 patients at a children's hospital in London, and 11 patients at Cardiff, Wales. Data were analyzed from April through July 2020. MAIN OUTCOMES AND MEASURES Risk of relapse and annualized relapse rate were evaluated according to different baseline features, including onset age, onset phenotype, and incident vs nonincident group, with the incident group defined as patients diagnosed with antibodies against myelin oligodendrocyte glycoprotein before a second attack. Time to next relapse among patients experiencing relapse was measured and compared between the maintenance therapy subgroup and each first-line treatment group. The no-treatment group was defined as the off-treatment phase among patients who were relapsing, which could occur between any attack or between the last attack and last follow-up. RESULTS Among 276 patients with MOGAD, 183 patients were identified as being part of the incident group. There were no differences in mean (SD) onset age between total and incident groups (26.4 [17.6] years vs 28.2 [18.1] years), and female patients were predominant in both groups (166 [60.1%] female patients vs 106 [57.9%] female patients). The most common presentation overall was optic neuritis (ON) (119 patients among 275 patients with presentation data [43.3%]), while acute disseminated encephalomyelitis (ADEM), brain, or brainstem onset was predominant among 69 patients aged younger than 12 years (47 patients [68.1%]), including 41 patients with ADEM (59.4%). In the incident group, the 8-year risk of relapse was 36.3% (95% CI, 27.1%-47.5%). ON at onset was associated with increased risk of relapse compared with transverse myelitis at onset (hazard ratio [HR], 2.66; 95% CI, 1.01-6.98; P = .047), but there was no statistically significant difference with adjustment for a follow-on course of corticosteroids. Any TM at onset (ie, alone or in combination with other presentations [ie, ON or ADEM, brain, or brain stem]) was associated with decreased risk of relapse compared with no TM (HR, 0.41; 95% CI, 0.20-0.88; P = .01). Young adult age (ie, ages >18-40 years) was associated with increased risk of relapse compared with older adult age (ie, ages >40 years) (HR, 2.71; 95% CI, 1.18-6.19; P = .02). First-line maintenance therapy was associated with decreased risk of relapse when adjusted for covariates (prednisolone: HR, 0.33; 95% CI, 0.12-0.92; P = .03; prednisolone, nonsteroidal immunosuppressant, or combined: HR, 0.51; 95% CI, 0.28-0.92; P = .03) compared with the no-treatment group. CONCLUSIONS AND RELEVANCE The findings of this cohort study suggest that onset age and onset phenotype should be considered when assessing subsequent relapse risk and that among patients experiencing relapse, prednisolone, first-line immunosuppression, or a combination of those treatments may be associated with decreased risk of future relapse by approximately 2-fold. These results may contribute to individualized treatment decisions.
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Affiliation(s)
- Chanjira Satukijchai
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
- Neuroscience Center, Bangkok International Hospital, Bangkok, Thailand
- Division of Neurology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Romina Mariano
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Silvia Messina
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
- Department of Clinical Neurology, John Radcliffe Hospital, Oxford University Hospitals Trust, Oxford, United Kingdom
| | - Mario Sa
- Paediatric Neurology, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Mark R. Woodhall
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Neil P. Robertson
- Department of Neurology, Division of Psychological Medicine and Clinical Neuroscience, Cardiff University, University Hospital of Wales, Cardiff, United Kingdom
| | - Lim Ming
- Children’s Neurosciences, Evelina London Children’s Hospital at Guy’s and St Thomas’ National Health Service Foundation Trust, London, United Kingdom
- Department of Women and Children’s Health, School of Life Course Sciences, King’s College London, United Kingdom
| | - Evangeline Wassmer
- Birmingham Women’s and Children’s National Health Service Foundation Trust, Birmingham, United Kingdom
- School of Life and Health Sciences, Aston University, Birmingham, United Kingdom
| | - Rachel Kneen
- Alder Hey Children's National Health Service Foundation Trust, Liverpool, United Kingdom
| | - Saif Huda
- Department of Neurology, Walton Centre National Health Service Foundation Trust, Liverpool, United Kingdom
| | - Anu Jacob
- Department of Neurology, Walton Centre National Health Service Foundation Trust, Liverpool, United Kingdom
- Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Camilla Blain
- St George’s University Hospitals National Health Service Foundation Trust, London, United Kingdom
| | - Christopher Halfpenny
- University Hospitals Southampton National Health Service Foundation Trust, Southampton, United Kingdom
| | - Cheryl Hemingway
- Department of Paediatric Neurology, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Eoin O'Sullivan
- Department of Ophthalmology, Kings College Hospital, London, United Kingdom
| | - Jeremy Hobart
- Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, United Kingdom
- University Hospitals Plymouth National Health Service Foundation Trust, United Kingdom
| | - Leonora K. Fisniku
- University Hospitals Sussex National Health Service Foundation Trust, Brighton, United Kingdom
- Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Roswell Martin
- Gloucestershire Hospitals National Health Service Foundation Trust, Gloucestershire, United Kingdom
| | - Ruth Dopson
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Queen Mary University London, London, United Kingdom
- Royal London Hospital, Barts Health National Health Service Foundation Trust, United Kingdom
| | - Sarah A. Cooper
- University Hospitals Sussex National Health Service Foundation Trust, Brighton, United Kingdom
| | - Victoria Williams
- Guy’s and St Thomas’ National Health Service Foundation Trust, London, United Kingdom
| | - Patrick J. Waters
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Sithara Ramdas
- Department of Paediatric Neurology, John Radcliffe Hospital, Oxford, United Kingdom
| | - Maria Isabel Leite
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
- Department of Clinical Neurology, John Radcliffe Hospital, Oxford University Hospitals Trust, Oxford, United Kingdom
| | - Jacqueline Palace
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
- Department of Clinical Neurology, John Radcliffe Hospital, Oxford University Hospitals Trust, Oxford, United Kingdom
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Huda S, Whittam D, Jackson R, Karthikeayan V, Kelly P, Linaker S, Mutch K, Kneen R, Woodhall M, Murray K, Hunt D, Waters P, Jacob A. Predictors of relapse in MOG antibody associated disease: a cohort study. BMJ Open 2021; 11:e055392. [PMID: 34848526 PMCID: PMC8634280 DOI: 10.1136/bmjopen-2021-055392] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To identify factors predictive of relapse risk and disability in myelin oligodendrocyte glycoprotein associated disease (MOGAD). SETTING Patients were seen by the neuromyelitis optica spectrum disorders (NMOSD) service in Liverpool, UK, a national referral centre for adult patients with MOGAD, NMOSD and related conditions. PARTICIPANTS Patients with MOGAD=76 from England, Northern Ireland and Scotland were included in this cohort study. RESULTS Relapsing disease was observed in 55% (42/76) of cases. Steroid treatment >1 month (OR 0.2, 95% CI 0.05 to 0.80; p=0.022), transverse myelitis (TM) at first attack (OR 0.03, 95% CI 0.004 to 0.23; p=0.001) and male sex (OR 0.16, 95% CI 0.04 to 0.68; p=0.014) were associated with monophasic disease (area under the curve=0.85). Male sex (HR 0.46, 95% CI 0.24 to 0.89; p=0.011) and TM at disease onset (HR 0.42, 95% CI 0.22 to 0.82; p=0.011) were also associated with an increased latency to first relapse. 45% (32/71) of patients became MOG-antibody negative and in relapsing patients negative seroconversion was associated with a lower relapse risk (relative risk 0.11 95% CI 0.05 to 0.26; p<0.001). No specific factors were predictive of visual or overall disability. CONCLUSIONS Male patients with spinal cord involvement at disease onset have a lower risk of relapsing disease and longer latency to first relapse. Steroid treatment for at least 1 month at first attack was also associated with a monophasic disease course. MOG-antibody negative seroconversion was associated with a lower risk of relapse and may help inform treatment decisions and duration.
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Affiliation(s)
- Saif Huda
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Daniel Whittam
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK
- Department of Neurology, Salford Royal Hospital, Salford, UK
| | - Richard Jackson
- Liverpool Cancer Trials Unit, University of Liverpool, Liverpool, Merseyside, UK
| | | | - Patricia Kelly
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Sam Linaker
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Kerry Mutch
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Rachel Kneen
- Department of Neurology, Alder Hey Children's NHS Foundation Trust, Liverpool, Merseyside, UK
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | - Mark Woodhall
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Katy Murray
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, UK
| | - David Hunt
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, UK
- UK Dementia Research Institute, University of Edinburgh, Edinburgh, Scotland
| | - Patrick Waters
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Anu Jacob
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK
- Department of Neurology, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
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Hughes AM, Ponsonby AL, Dear K, Dwyer T, Taylor BV, van der Mei I, Valery PC, Lucas RM. Childhood infections, vaccinations, and tonsillectomy and risk of first clinical diagnosis of CNS demyelination in the Ausimmune Study. Mult Scler Relat Disord 2020; 42:102062. [PMID: 32305688 DOI: 10.1016/j.msard.2020.102062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 03/11/2020] [Accepted: 03/16/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND The association between childhood vaccinations and infections and risk of multiple sclerosis is unclear; few studies have considered age at vaccination/infection. OBJECTIVE To explore age-related associations between childhood vaccinations, infection and tonsillectomy and risk of a first clinical diagnosis of CNS demyelination. METHODS Data on case (n = 275, 76.6% female; mean age 38.6 years) and age- and sex-matched control (n = 529) participants in an incident population-based case-control study included self-reported age at time of childhood vaccinations, infections, and tonsillectomy. Conditional logistic regression models were used to calculate adjusted odds ratios (AOR) and 95% confidence intervals (CI). RESULTS Poliomyelitis vaccination prior to school-age was associated with increased risk of a first clinical diagnosis of CNS demyelination (AOR = 2.60, 95%CI 1.02-6.68), based on a very small unvaccinated reference group. Late (11-15 years) rubella vaccination (compared to none) was associated with lower odds of being a case (AOR = 0.47, 95%CI 0.27-0.83). Past infectious mononucleosis at 11-15 years (AOR = 2.84, 95%CI 1.0-7.57) and 16-20 years (AOR = 1.92, 95%CI 1.12-3.27) or tonsillectomy in adolescence (11-15 years: AOR = 2.45, 95%CI 1.12-5.35), including after adjustment for IM, were associated with increased risk of a first clinical diagnosis of CNS demyelination. CONCLUSIONS Age at vaccination, infection or tonsillectomy may alter the risk of subsequent CNS demyelination. Failing to account for age effects may explain inconsistencies in past findings.
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Affiliation(s)
- A M Hughes
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australian Capital Territory, Australia; The Canberra Hospital, Canberra, Australia
| | - A-L Ponsonby
- The Florey Institute of Neuroscience and Mental Health, Melbourne, Australia; Murdoch Childrens Research Institute, University of Melbourne, Melbourne, Australia
| | - K Dear
- School of Public Health, University of Adelaide, Adelaide, Australia
| | - T Dwyer
- Murdoch Childrens Research Institute, University of Melbourne, Melbourne, Australia
| | - B V Taylor
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - I van der Mei
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - P C Valery
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - R M Lucas
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australian Capital Territory, Australia; Centre for Ophthalmology and Visual Science, University of Western Australia, Perth, Australia.
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McLeod JG, Pollard JD, Macaskill P, Mohamed A, Spring P, Khurana V. Prevalence of chronic inflammatory demyelinating polyneuropathy in New South Wales, Australia. Ann Neurol 1999; 46:910-3. [PMID: 10589544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
A prevalence study of chronic inflammatory demyelinating polyneuropathy (CIDP) was performed in New South Wales (NSW), Australia, with a prevalence day of August 6, 1996, which coincided with a national census. The population of NSW was 5,995,544, and the crude prevalence of CIDP was 1.9 per 100,000 population. It was higher in male patients than in female patients, and the age-specific prevalence reached a maximum of 6.7 per 100,000 population in the 70- to 79-year-old age group. The prevalence in the city of Newcastle, with a population of 448,663, was 2.0 per 100,000 population and is representative of the whole of NSW. The estimated crude annual incidence was 0.15 per 100,000 population. The mean age of onset was 47.6 years (median, 53.5 years), 51% of patients had a relapsing-remitting course, the mean duration on prevalence day was 7.1 years (median, 5 years), and 87% of patients were able to walk without walking aids or other assistance.
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Affiliation(s)
- J G McLeod
- Department of Medicine, University of Sydney and Institute of Clinical Neurosciences, Royal Prince Alfred Hospital and the University of Sydney, New South Wales, Australia
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