TOPLINE:

Discontinuation of maintenance therapy for myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) was associated with fewer relapses than continued treatment, new research showed. Factors linked to reduced risk for future relapse included treatment duration exceeding 1 year and an interval of more than 2 years since the last relapse.

METHODOLOGY:

• A retrospective multicenter cohort study of 705 adults (median age at disease onset, 37 years; 54% women) with MOGAD diagnosed between 2013 and 2024 was conducted using the French NOMADMUS database.
• Treatment discontinuation was defined as cessation of therapy for a set duration: at least 1 month for oral immunosuppressants (azathioprine or mycophenolate mofetil), at least 1 year for rituximab, 2 months for tocilizumab, and 3 months for intravenous immunoglobulin.
• Discontinuations in 83 patients (median age, 43 years; 63% women) were analyzed. Of these, 60 patients were on oral immunosuppressants, and 23 were on rituximab. These discontinuations were either scheduled (65%) or related to adverse events (35%).
• Outcomes included time to first relapse following discontinuation of maintenance therapy and factors associated with the time to discontinuation.

TAKEAWAY:

• The cumulative incidence of relapse at 1 year after treatment discontinuation was 9% (95% CI, 1.0-15.9), with a median time to relapse of 0.5 years.
• Patients who discontinued maintenance therapy experienced significantly fewer relapses than those who continued treatment (P = .008).
• Treatment duration of less than 1 year (P = .002) and an interval of less than 2 years since the last relapse (P = .01) were associated with an increased risk for relapse (19% and 16% of cases, respectively).
• Relapses after treatment discontinuation were mild, with a median score change of 0 points on the Expanded Disability Status Scale (EDSS); last available EDSS scores ranged from 0 to 2.5. There were no significant differences in relapse risk between scheduled and adverse event-related discontinuations.

IN PRACTICE:

“The low risk of disease reactivation found in this study suggests that discontinuing treatment may be considered in selected adult patients with MOGAD,” the investigators wrote.

“Further prospective studies with longer follow-up and dedicated clinical trials are needed to refine discontinuation strategies and identify factors influencing disease reactivation,” they added.

SOURCE:

The study was led by Marine Boudot de la Motte, MD, Rothschild Foundation Hospital, Paris, France. It was published online on March 23 in JAMA Neurology.

LIMITATIONS:

The study was limited by the exclusion of pediatric patients, relatively short median durations of disease and follow-up, an underrepresentation of other treatments such as tocilizumab and intravenous immunoglobulin, and a lack of evaluation of discontinuation of oral corticosteroids.

DISCLOSURES:

Funding information was not provided for this study. Several investigators reported having financial or other ties with various pharmaceutical companies, which are fully listed in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.