{"doi":"10.1001/jamaneurol.2022.0489","title":"Association of Maintenance Intravenous Immunoglobulin With Prevention of Relapse in Adult Myelin Oligodendrocyte Glycoprotein Antibody–Associated Disease","abstract":"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.","journal":"JAMA Neurology","year":2022,"id":233803,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":115,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9543,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2022-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":642609,"name":"Saif Huda","orcid":"0000-0003-0980-3750","position":1,"is_corresponding":false},{"id":615359,"name":"Yael Hacohen","orcid":"0000-0001-8490-9657","position":2,"is_corresponding":false},{"id":848183,"name":"Michael Levy","orcid":"0000-0002-7969-8346","position":3,"is_corresponding":false},{"id":848184,"name":"Itay Lotan","orcid":"0000-0002-4015-9783","position":4,"is_corresponding":false},{"id":848185,"name":"Adi Wilf‐Yarkoni","orcid":"0000-0002-2584-5793","position":5,"is_corresponding":false},{"id":642604,"name":"Hadas Stiebel‐Kalish","orcid":"0000-0001-7715-6706","position":6,"is_corresponding":false},{"id":848186,"name":"Mark A. Hellmann","orcid":"0000-0002-0010-9407","position":7,"is_corresponding":false},{"id":241641,"name":"Elias S. Sotirchos","orcid":"0000-0002-8812-1637","position":8,"is_corresponding":false},{"id":739661,"name":"Amanda D. Henderson","orcid":"0000-0002-8676-4292","position":9,"is_corresponding":false},{"id":231254,"name":"Sean J. Pittock","orcid":"0000-0002-6140-5584","position":10,"is_corresponding":false},{"id":286578,"name":"M. Tariq Bhatti","orcid":"0000-0001-7190-5630","position":11,"is_corresponding":false},{"id":848187,"name":"Eric Eggenberger","orcid":"0000-0002-1205-4036","position":12,"is_corresponding":false},{"id":848188,"name":"Marie A. Di Nome","orcid":"0000-0003-1007-8947","position":13,"is_corresponding":false},{"id":642593,"name":"Ho Jin Kim","orcid":"0000-0002-8672-8419","position":14,"is_corresponding":false},{"id":848189,"name":"Su‐Hyun Kim","orcid":"0000-0002-0679-0918","position":15,"is_corresponding":false},{"id":687625,"name":"Albert Saiz","orcid":"0000-0002-5793-8791","position":16,"is_corresponding":false},{"id":18655,"name":"Friedemann Paul","orcid":"0000-0002-6378-0070","position":17,"is_corresponding":false},{"id":236509,"name":"Russell C. Dale","orcid":"0000-0002-2495-1826","position":18,"is_corresponding":false},{"id":236498,"name":"Sudarshini Ramanathan","orcid":"0000-0002-0294-9768","position":19,"is_corresponding":false},{"id":615363,"name":"Jacqueline Palace","orcid":"0000-0003-4779-6133","position":20,"is_corresponding":false},{"id":848190,"name":"Valentina Camera","orcid":"0000-0002-4925-9000","position":21,"is_corresponding":false},{"id":642595,"name":"Maria Isabel Leite","orcid":"0000-0003-4407-5066","position":22,"is_corresponding":false},{"id":396779,"name":"Byron L. Lam","orcid":"0000-0002-1233-2366","position":23,"is_corresponding":false},{"id":226913,"name":"Jeffrey L. Bennett","orcid":"0000-0002-3346-1394","position":24,"is_corresponding":false},{"id":761766,"name":"Sara Mariotto","orcid":"0000-0002-7806-3103","position":25,"is_corresponding":false},{"id":848891,"name":"Dave Hodge","orcid":null,"position":26,"is_corresponding":false},{"id":316587,"name":"Bertrand Audoin","orcid":"0000-0002-9860-7657","position":27,"is_corresponding":false},{"id":281942,"name":"Élisabeth Maillart","orcid":"0000-0001-7699-0328","position":28,"is_corresponding":false},{"id":848191,"name":"Romain Deschamps","orcid":"0000-0001-6291-8771","position":29,"is_corresponding":false},{"id":848192,"name":"Julie Pique","orcid":"0000-0002-1986-7945","position":30,"is_corresponding":false},{"id":231250,"name":"Eoin P. Flanagan","orcid":"0000-0002-6661-2910","position":31,"is_corresponding":false},{"id":615864,"name":"Romain Marignier","orcid":"0000-0002-5967-2800","position":32,"is_corresponding":false},{"id":286579,"name":"John J. Chen","orcid":"0000-0003-3644-7528","position":0,"is_corresponding":true}],"reference_count":31,"raw_metadata":null,"created_at":"2026-07-19T00:21:31.237180Z","pmid":"35377395","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}