Differential efficacy of mycophenolate mofetil in adults with relapsing myelin oligodendrocyte glycoprotein antibody-associated disorders

Meisheng Wang; Pei Zeng; Chen Du; Huiru Xue; Zhigang Cui; Huiming Zhang; Dongmei Jia; Chao Zhang

doi:10.1016/j.msard.2021.103035

Differential efficacy of mycophenolate mofetil in adults with relapsing myelin oligodendrocyte glycoprotein antibody-associated disorders

Mult Scler Relat Disord. 2021 Aug:53:103035. doi: 10.1016/j.msard.2021.103035. Epub 2021 May 24.

Authors

Meisheng Wang¹, Pei Zeng¹, Chen Du¹, Huiru Xue², Zhigang Cui³, Huiming Zhang³, Dongmei Jia¹, Chao Zhang⁴

Affiliations

¹ Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China.
² Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, China.
³ Department of Neurology, The Third People's Hospital of Datong, Datong, China.
⁴ Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China. Electronic address: chaozhang@tmu.edu.cn.

PMID: 34077831
DOI: 10.1016/j.msard.2021.103035

Abstract

Background: Myelin oligodendrocyte glycoprotein-immunoglobulin (MOG-IgG) associated disorder (MOGAD) has been recognized as a distinct disease entity with recurrent attacks. But the standard therapeutic approach to reduce relapses is unknown. Different doses of mycophenolate mofetil (MMF) are frequently used in MOGAD. We aimed to investigate the response to stratified doses of MMF in adult patients with MOGAD.

Methods: We determined the frequency of relapses in patients receiving various doses of MMF treatment for MOGAD. Patients were reviewed for relapses before and during long-term treatment. Cox proportional hazards models were used to analyze the correlation between the MMF dosage and the annualized relapse rate (ARR) as well as clinical features.

Results: 22 patients receiving low-dose MMF (< 1000 mg/day), 19 patients receiving moderate-dose MMF (1000 mg/day ≤ MMF dose < 2000 mg/day) and 21 patients receiving high-dose MMF (≥ 2000 mg/day) were collected in our cohort. Cox regression analysis showed that high-dose MMF treatment significantly reduced the risk of relapses (HR 0.501 [95% CI 0.268-0.934], p = 0.030) compared with low-dose and moderate-dose of MMF treatment, after adjusted by age, gender, disease duration and prednisone therapy. Patients (13/62) concomitant with autoimmune diseases, had a higher proportion of relapses (76.92%) compared with those without autoimmune diseases (18.37%) (HR = 5.96, 95% CI 1.73-20.48, p < 0.001). The overall median ARR reduced from 1.13 to 0.32 under high-dose MMF treatment (p = 0.004). However, there was no significant reduction in ARR either in patients with low-dose or those with moderate-dose of MMF.

Conclusion: This study suggests that high-dose of MMF treatment may reduce recurrent demyelinating attacks, with the lowest ARR. Randomized controlled studies are required to validate the effective therapeutic regimen.

Keywords: Annualized relapse rate; Mycophenolate mofetil; Myelin oligodendrocyte glycoprotein-immunoglobulin associated disorder (MOGAD).

MeSH terms

Cohort Studies
Humans
Mycophenolic Acid* / therapeutic use
Myelin-Oligodendrocyte Glycoprotein
Proportional Hazards Models
Recurrence

Substances

Myelin-Oligodendrocyte Glycoprotein
Mycophenolic Acid