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Cited by 66Multiple Sclerosis Research StudiesPeripheral Neuropathies and DisordersAutoimmune Neurological Disorders and Treatments

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Long-term efficacy of mycophenolate mofetil in myelin oligodendrocyte glycoprotein antibody-associated disorders: A prospective study

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Li, Shengde, Ren, Haitao, Xu, Yan, Xu, Tao, Zhang, Yao, Yin, Hexiang, Zhang, Weihua, Li, Jiuwei, Ren, Xiaotun, Fang, Fang, Li, Wenhan, Zhu, Yicheng, Peng, Bin, Wang, Jing, Zhong, Yong, Cui, Liying·2020·Neurology Neuroimmunology & Neuroinflammation
DOI 10.1212/nxi.0000000000000705PMC PMC7136046
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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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Crossref · 10.1212/nxi.0000000000000705

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Figure 1 Selection of patients AZA = azathioprine; MMF = mycophenolate mofetil; MOG-IgG = myelin oligodendrocyte glycoprotein immunoglobulin G.
Figure 1 Selection of patients AZA = azathioprine; MMF = mycophenolate mofetil; MOG-IgG = myelin oligodendrocyte glycoprotein immunoglobulin G.CC BY-NC-ND · PubMed Central
Figure 2 Kaplan-Meier curves showing the probability of survival free of relapse in patients with an MOG-IgG-associated disorder Log-rank test: p < 0.001. Tick marks indicate censored patients. MMF = mycophenolate mofetil; MOG = myelin oligodendrocyte glycoprotein.
Figure 2 Kaplan-Meier curves showing the probability of survival free of relapse in patients with an MOG-IgG-associated disorder Log-rank test: p < 0.001. Tick marks indicate censored patients. MMF = mycophenolate mofetil; MOG = myelin oligodendrocyte glycoprotein.CC BY-NC-ND · PubMed Central
Figure 3 HRs for relapse in subgroup analyses (A) Other includes 3 patients who were pregnant/lactating and 7 with fatigue/poor sleep/tension. (B) Other includes 9 with cerebellum/brain stem involvement, 4 with optic neuritis and cerebrum involvement, 3 with myelitis and cerebrum involvement, 2 with optic neuritis and myelitis, 2 with cerebellum/brain stem and cerebrum involvement, and 2 with meningitis. (C) 0: patients with 1 attack before the index date; <3.0: patients with ≥2 attacks before the index date and ARR <3.0; ≥3.0: patients with ≥2 attacks before the index date and ARR ≥3.0. (D) Two missing datapoints. ARR = annualized relapse rate; HR = hazard ratio; MMF = mycophenolate mofetil; MOG = myelin oligodendrocyte glycoprotein.
Figure 3 HRs for relapse in subgroup analyses (A) Other includes 3 patients who were pregnant/lactating and 7 with fatigue/poor sleep/tension. (B) Other includes 9 with cerebellum/brain stem involvement, 4 with optic neuritis and cerebrum involvement, 3 with myelitis and cerebrum involvement, 2 with optic neuritis and myelitis, 2 with cerebellum/brain stem and cerebrum involvement, and 2 with meningitis. (C) 0: patients with 1 attack before the index date; <3.0: patients with ≥2 attacks before the index date and ARR <3.0; ≥3.0: patients with ≥2 attacks before the index date and ARR ≥3.0. (D) Two missing datapoints. ARR = annualized relapse rate; HR = hazard ratio; MMF = mycophenolate mofetil; MOG = myelin oligodendrocyte glycoprotein.CC BY-NC-ND · PubMed Central

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Metadata

Authors
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.
Affiliations
  • Capital Medical University (CN)
  • 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 &amp; 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...
Corresponding author
  • Xu, Yan
  • Xu, Tao
ORCID
Venue
Neurology Neuroimmunology & Neuroinflammation
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2020-05
Volume
7
Issue
3
ISSN
2332-7812 (ISSN-L)
DOI
10.1212/nxi.0000000000000705
PMC
PMC7136046
OpenAlex
W3011563890
Cited by
66
References
34
Citations by year
2026: 6 · 2025: 4 · 2024: 12 · 2023: 4 · 2022: 10 · 2021: 17 · 2020: 12
FWCI
7.07
Type
journal article
Language
en
Open access
Licence
cc-by-nc-nd
Locations
  • Neurology Neuroimmunology & Neuroinflammation (publishedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
Funders
  • Peking Union Medical College Hospital
  • Peking Union Medical College
  • National Key Research and Development Program of China (No.2016YFC0901500, [2016YFC0901500])
Topics
  • Health Sciences › Medicine › Clinical Neurology › Multiple Sclerosis Research Studies
  • Health Sciences › Medicine › Clinical Neurology › Peripheral Neuropathies and Disorders
  • Health Sciences › Medicine › Clinical Neurology › Autoimmune Neurological Disorders and Treatments
Keywords
mycophenolate mofetil, anti-MOG antibodies, relapse prevention, immunosuppressive therapy, relapse risk, demyelinating disease, long-term efficacy, treatment discontinuation
MeSH terms
Adolescent, Adult, Child, Drug Therapy, Combination, Female, Follow-Up Studies, Glucocorticoids, Humans, Immunoglobulin G, Immunologic Factors, Male, Mycophenolic Acid, Prospective Studies, Recurrence, Proportional Hazards Models, Outcome Assessment, Health Care, Demyelinating Autoimmune Diseases, CNS, Secondary Prevention, Young Adult, Myelin-Oligodendrocyte Glycoprotein

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