Abstract
Objectives We evaluated the association of oral corticosteroids (OCS) administered for the initial attack of myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) with the risk of relapse.
Methods We documented clinical presentation of MOGAD, immunotherapy administration, and time to first relapse among patients from the Australasian MOGAD Study Group who had at least 2 sufficiently documented consultations. A Cox proportional hazards model with OCS dose as a time-varying covariate examined the relationship between OCS and the hazard of first relapse, adjusted for IV corticosteroid therapy and age.
Results We evaluated 99 patients [(53 female; median age at disease onset 24 years (range 1–69 years); median follow-up duration 69 months (range 5–640 months)]. 67 patients experienced a relapse; median survival time to relapse was 16.4 months. The 57 patients treated with OCS had a median course duration of 47 days (range 5–1242 days ) with a median time from first symptoms to initiation of 12 days (range 0–61 days). Higher dose OCS following the initial attack of MOGAD was associated with a lower cumulative hazard (HR=0.97, 95%CI=0.95–0.998 p=0.03). In this model, no evidence was found to support IV corticosteroid dosage modifying relapse risk (p=0.23).
Conclusions Higher doses of OCS following the initial attack of MOGAD are associated with a lower hazard of early relapse. On average, for every 1mg increase in oral prednisolone dose, the cumulative hazard of relapse decreased by 3%. These results have the potential to inform the development of evidence-based treatment strategies for this increasingly recognised CNS autoimmune disorder.
