JAMA: IV Immunoglobulin shown to lower MOGAD relapse in adults

USA: In a new study conducted by John J. Chen and team showed that in adult patients with myelin oligodendrocyte glycoprotein antibody - associated disease (MOGAD), intravenous immunoglobulin (IVIG) was linked with a lower relapse frequency. The findings of this study were published in the Journal of American Medical Association - Neurology.

Recent research suggests that maintenance intravenous immunoglobulin may be an effective treatment for preventing relapses in myelin oligodendrocyte glycoprotein antibody–associated disease; however, the majority of these studies included pediatric cohorts, and few studies have evaluated IVIG in adult patients. As a result, this study was carried out to assess the relationship between maintenance IVIG and the prevention of illness recurrence in a large adult cohort of MOGAD patients.

This retrospective cohort study took place between January 1, 2010 and October 31, 2021. Patients were enrolled in the study if they (1) showed a history of 1 or more central nervous system demyelinating events consistent with MOGAD, (2) had MOG-IgG seropositivity determined by cell-based assay, and (3) were 18 years or older upon initiating IVIG therapy. These individuals were assessed retrospectively for a history of IVIG maintenance therapy. This research included participants who received IVIG. The major outcomes and measures were recurrence rates while on maintenance IVIG vs before starting treatment.

The key findings of this study were as follow:

1. 59 of the 876 adult patients initially diagnosed with MOGAD were given maintenance IVIG.

2. IVIG was started as first-line immunotherapy in 15 patients (25%) and as second-line treatment in 37 patients (63%) due to prior immunotherapy failure and in 7 patients (12%) due to intolerance to prior immunotherapy.

3. Prior to IVIG therapy, the median (range) annualized relapse rate was 1.4 (0-6.1), compared to a median (range) annualized relapse rate of 0 when taking IVIG (0-3).

4. Twenty patients (34%) experienced at least one relapse while taking IVIG, with a median (range) duration to first relapse of 1 (0.03-4.8) years, while 17 patients (29%) received concurrent maintenance immunotherapy.

5. 5 of 29 patients (17%) who got 1 g/kg IVIG every 4 weeks or more had disease recurrence, compared to 15 of 30 patients (50%) who had lower or less frequent dose.

6. At the end of the study, 52 patients (88%) were still receiving IVIG after a median (range) of 1.7 (0.5-9.9) years of treatment.

7. 7 of 59 patients (12%) terminated IVIG therapy, including four (57%) due to inefficacy, two (29%), due to side effects, and one (14%), due to a trial not getting therapy after a period of illness dormancy.

In conclusion, treatment failure may be related to less frequent and lower IVIG dosage. Prospective randomized clinical studies are needed in the future to validate these findings.

Reference:

Chen JJ, Huda S, Hacohen Y, et al. Association of Maintenance Intravenous Immunoglobulin With Prevention of Relapse in Adult Myelin Oligodendrocyte Glycoprotein Antibody–Associated Disease. JAMA Neurol. Published online April 04, 2022. doi:10.1001/jamaneurol.2022.0489

Keywords: immunoglobulin, neurology, immunotherapy, myelin oligodendrocyte glycoprotein antibody, relapse, dormant disease, seropositivity, blood test, intravenous, John J Chen, JAMA