Association of Maintenance Intravenous Immunoglobulin With Prevention of Relapse in Adult Myelin Oligodendrocyte Glycoprotein Antibody–Associated Disease - Sorbonne Université
Article Dans Une Revue JAMA neurology Année : 2022

Association of Maintenance Intravenous Immunoglobulin With Prevention of Relapse in Adult Myelin Oligodendrocyte Glycoprotein Antibody–Associated Disease

John Chen
  • Fonction : Auteur
Saif Huda
  • Fonction : Auteur
Yael Hacohen
  • Fonction : Auteur
Michael Levy
  • Fonction : Auteur
Itay Lotan
  • Fonction : Auteur
Adi Wilf-Yarkoni
  • Fonction : Auteur
Hadas Stiebel-Kalish
  • Fonction : Auteur
Mark Hellmann
  • Fonction : Auteur
Elias Sotirchos
  • Fonction : Auteur
Amanda Henderson
  • Fonction : Auteur
Sean Pittock
  • Fonction : Auteur
M. Tariq Bhatti
  • Fonction : Auteur
Eric Eggenberger
  • Fonction : Auteur
Marie Di Nome
  • Fonction : Auteur
Ho Jin Kim
  • Fonction : Auteur
Su-Hyun Kim
  • Fonction : Auteur
Albert Saiz
  • Fonction : Auteur
Friedemann Paul
  • Fonction : Auteur
Russell Dale
  • Fonction : Auteur
Sudarshini Ramanathan
  • Fonction : Auteur
Jacqueline Palace
  • Fonction : Auteur
Valentina Camera
  • Fonction : Auteur
Maria Isabel Leite
  • Fonction : Auteur
Byron Lam
  • Fonction : Auteur
Jeffrey Bennett
  • Fonction : Auteur
Sara Mariotto
  • Fonction : Auteur
Dave Hodge
  • Fonction : Auteur
Bertrand Audoin
  • Fonction : Auteur
Romain Deschamps
  • Fonction : Auteur
Julie Pique
  • Fonction : Auteur
Eoin Flanagan
  • Fonction : Auteur
Romain Marignier

Résumé

Importance: Recent studies suggest that maintenance intravenous immunoglobulin (IVIG) may be an effective treatment to prevent relapses in myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD); however, most of these studies had pediatric cohorts, and few studies have evaluated IVIG in adult patients. Objective: To determine the association of maintenance IVIG with the prevention of disease relapse in a large adult cohort of patients with MOGAD. Design, setting, and participants: This was a retrospective cohort study conducted from January 1, 2010, to October 31, 2021. Patients were recruited from 14 hospitals in 9 countries and were included in the analysis if they (1) had a history of 1 or more central nervous system demyelinating attacks consistent with MOGAD, (2) had MOG-IgG seropositivity tested by cell-based assay, and (3) were age 18 years or older when starting IVIG treatment. These patients were retrospectively evaluated for a history of maintenance IVIG treatment. Exposures: Maintenance IVIG. Main outcomes and measures: Relapse rates while receiving maintenance IVIG compared with before initiation of therapy. Results: Of the 876 adult patients initially identified with MOGAD, 59 (median [range] age, 36 [18-69] years; 33 women [56%]) were treated with maintenance IVIG. IVIG was initiated as first-line immunotherapy in 15 patients (25%) and as second-line therapy in 37 patients (63%) owing to failure of prior immunotherapy and in 7 patients (12%) owing to intolerance to prior immunotherapy. The median (range) annualized relapse rate before IVIG treatment was 1.4 (0-6.1), compared with a median (range) annualized relapse rate while receiving IVIG of 0 (0-3) (t108 = 7.14; P < .001). Twenty patients (34%) had at least 1 relapse while receiving IVIG with a median (range) time to first relapse of 1 (0.03-4.8) years, and 17 patients (29%) were treated with concomitant maintenance immunotherapy. Only 5 of 29 patients (17%) who received 1 g/kg of IVIG every 4 weeks or more experienced disease relapse compared with 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, 52 patients (88%) were still receiving maintenance IVIG with a median (range) duration of 1.7 (0.5-9.9) years of therapy. Seven of 59 patients (12%) discontinued IVIG therapy: 4 (57%) for inefficacy, 2 (29%) for adverse effects, and 1 (14%) for a trial not receiving therapy after a period of disease inactivity. Conclusions and relevance: Results of this retrospective, multicenter, cohort study of adult patients with MOGAD suggest that maintenance IVIG was associated with a reduction in disease relapse. Less frequent and lower dosing of IVIG may be associated with treatment failure. Future prospective randomized clinical trials are warranted to confirm these findings.
Maintenance IVIG.

Dates et versions

hal-04576065 , version 1 (15-05-2024)

Identifiants

Citer

John Chen, Saif Huda, Yael Hacohen, Michael Levy, Itay Lotan, et al.. Association of Maintenance Intravenous Immunoglobulin With Prevention of Relapse in Adult Myelin Oligodendrocyte Glycoprotein Antibody–Associated Disease. JAMA neurology, 2022, 79 (5), pp.518. ⟨10.1001/jamaneurol.2022.0489⟩. ⟨hal-04576065⟩
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