Myelin oligodendrocyte glycoprotein antibody–associated disease in a modern, population-based cohort

BACKGROUND AND OBJECTIVE: The risk of myelin oligodendrocyte glycoprotein antibody-associated disease relapses in new-onset patients and whether this is modified by immunotherapies is uncertain. METHOD: To assess relapse risk, we conducted a retrospective population-based cohort study of people with myelin oligodendrocyte glycoprotein antibody-associated disease diagnosed at symptom onset during 2019-2024. RESULTS: We identified 69 eligible patients (mean age = 27.6 years), 30 (43.5%) were under 18 years old, and 36 (52.2%) were female. Corticosteroids were initiated within 8 days (median, interquartile range = 5-17) after symptom onset in most patients (n = 65). Twenty-two patients (31.9%) were treated acutely with other immunotherapies, but only 11 (15.9%) received empiric prophylaxis. After a median follow-up of 31.9 months (interquartile range = 23.0-48.9), most (n = 57, 82.6%) had made full recoveries; only three (10.0%) pediatric and five of 39 (12.8%) adult patients relapsed; and only three (4.3%) were left with moderate-to-severe deficits (all relapse-free). There was no significant association between demographic, clinical or treatment characteristics and relapse risk. CONCLUSION: These findings are reassuring for people with myelin oligodendrocyte glycoprotein antibody-associated disease diagnosed at symptom onset. The risk of relapse and permanent deficits appears to be low even without prophylactic immunotherapy or prolonged corticosteroid tapers when onset symptoms are treated promptly with corticosteroids and/or other immunotherapies.