背景:髓磷脂少突胶质细胞糖蛋白抗体相关疾病(MOGAD)是一种最近描述的脱髓鞘疾病,儿童约占所有病例的50%。几乎一半的患者经历复发,但是很少有研究评估复发风险的预测因子,具有挑战性的临床管理。该研究旨在确定与复发过程相关的MOGAD发作的预测因子。
方法:前瞻性地收集了美国儿科MS中心网络看到的MOGAD儿科患者的数据。单变量和校正多变量模型用于预测疾病复发。
结果:我们确定了326例MOGAD病例(首次事件的平均年龄8.9岁[SD4.3],57%为女性,77%的白人和74%的非西班牙裔)和46%的复发平均随访3.9年(SD4.1)。在调整后的多变量模型中,女性(HR1.66,95%CI1.17~2.36,p=0.004)和西班牙裔/拉丁裔(HR1.77,95%CI1.19~2.64,p=0.005)与MOGAD复发风险较高相关.在多变量分析中,在第二次事件发生前开始使用利妥昔单抗(HR0.25,95%CI0.07至0.92,p=0.037)或静脉注射免疫球蛋白(IVIG)(HR0.35,95%CI0.14至0.88,p=0.026)的维持治疗与第二次事件的较低风险相关。相反,维持类固醇与较高的估计复发风险相关(HR1.76,95%CI0.90~3.45,p=0.097).
结论:性别和种族与复发性MOGAD相关。发病后不久使用利妥昔单抗或IVIG治疗与第二次事件的较低风险相关。对于复发风险较高的患者,可以考虑在第一次事件后进行预防性治疗。
BACKGROUND: Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a recently described demyelinating disorder, and children represent about 50% of all cases. Almost half of the patients experience relapses, but very few studies have evaluated predictors of relapse risk, challenging clinical management. The study aimed to identify predictors at MOGAD onset that are associated with a relapsing course.
METHODS: Prospectively collected data from paediatric patients with MOGAD seen by the US Network of Paediatric MS Centres were leveraged. Univariable and adjusted multivariable models were used to predict recurrent disease.
RESULTS: We identified 326 MOGAD cases (mean age at first event 8.9 years [SD 4.3], 57% female, 77% white and 74% non-Hispanic) and 46% relapsed during a mean follow-up of 3.9 years (SD 4.1). In the adjusted multivariable model, female sex (HR 1.66, 95% CI 1.17 to 2.36, p=0.004) and Hispanic/Latino ethnicity (HR 1.77, 95% CI 1.19 to 2.64, p=0.005) were associated with a higher risk of relapsing MOGAD. Maintenance treatment initiated before a second event with rituximab (HR 0.25, 95% CI 0.07 to 0.92, p=0.037) or intravenous immunoglobulin (IVIG) (HR 0.35, 95% CI 0.14 to 0.88, p=0.026) was associated with lower risk of a second event in multivariable analyses. Conversely, maintenance steroids were associated with a higher estimated relapse risk (HR 1.76, 95% CI 0.90 to 3.45, p=0.097).
CONCLUSIONS: Sex and ethnicity are associated with relapsing MOGAD. Use of rituximab or IVIG therapy shortly after onset is associated with a lower risk of the second event. Preventive treatment after a first event could be considered for those with a higher relapse risk.