Maintenance IVIG Lowers Reduces Relapse in Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease

Maintenance therapy with intravenous immunoglobulin (IVIG) may help prevent relapses in patients with myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD), according to a study published in JAMA Neurology.

According to the investigators, recent studies that indicated the efficacy of IVIG in this patient population used pediatric cohorts, with few evaluations of the treatment approach in adults. For the current study, the investigators sought to evaluate the association of maintenance IVIG with incidents of disease relapse in a large retrospective cohort study of adult patients with MOGAD.

The study was conducted from January 1, 2010, to October 31, 2021, with patients from 14 hospitals in 9 countries. Individuals were included in the analysis if they had a history of 1 or more central nervous system demyelinating attacks consistent with MOGAD; if they had MOG-IgG seropositivity tested by cell-based assay; and if they were 18 years of age or older when IVIG therapy was initiated.

The cohort was retrospectively analyzed for a history of maintenance IVIG treatment. The investigators then compared relapse rates during maintenance IVIG therapy versus prior to initiation of therapy.

Among 876 adults who were initially identified with MOGAD, 59 patients (median [range] age, 36 [18-69] years; 33 women [56%]) were administered maintenance IVIG. The treatment was initiated as first-line immunotherapy in 15 patients (25%) and as second-line therapy in 37 patients (63%) due to failure of prior immunotherapy and in 7 patients (12%) because of intolerance to prior immunotherapy.

The median (range) annualized relapse rate prior to initiation of IVIG treatment was 1.4 (0-6.1) versus a median (range) annualized relapse rate of 0 (0-3) (t108 = 7.14; P < .001) during treatment with IVIG. Further, 20 (34%) patients had at least 1 relapse during IVIG therapy with a median (range) time to first relapse of 1 (0.03-4.8) years, with 17 patients (29%) administered concomitant maintenance immunotherapy.

The investigators found that 5 of 29 patients (17%) administered 1 g/kg of IVIG every 4 weeks or more experienced disease relapse versus 15 of 30 patients (50%) treated with lower or less frequent dosing (hazard ratio, 3.31; 95% CI, 1.19-9.09; P = .02).

At final follow-up, the results showed that 52 patients (88%) were still being administered maintenance IVIG with a median (range) duration of 1.7 (0.5-9.9) years of therapy. Further, 7 of 59 patients (12%) discontinued IVIG therapy, 4 (57%) of whom because of inefficacy, 2 (29%) of whom for adverse effects, and 1 (14%) who was not administered therapy following a period of disease inactivity.

The researchers concluded that maintenance treatment with IVIG was associated with lower disease relapse rates in adult patients with MOGAD. They added that less frequent and reduced dosing of IVIG may be linked to treatment failure; however, future prospective randomized clinical trials are needed to confirm these findings.

Reference

JAMA Neurol. 2022 Apr 4. doi: 10.1001/jamaneurol.2022.0489. Online ahead of print. Accessed April 8, 2022.