Neuroinflammation
Therapeutic de-escalation strategies are increasingly being considered for demyelinating diseases to limit the risks associated with prolonged immunosuppression. Unlike multiple sclerosis and neuromyelitis optica spectrum disorder, which carry a high risk of relapse, relapsing forms of MOGAD (myelin oligodendrocyte glycoprotein antibody-associated disease) exhibit a non-linear disease course, with a higher risk of relapse during the first two years following symptom onset, followed by a marked decrease over time.
A large, multicenter (41 centers) retrospective cohort study, based on the French NOMADMUS database, examined the outcomes of 319 adult patients with MOGAD—diagnosed between January 2013 and April 2024—following the discontinuation of maintenance therapy. Among the 83 patients who discontinued maintenance therapy (oral immunosuppressants or rituximab), 7 relapsed, with a median time (IQR) to relapse of 0.5 (0.1–1.4) years. The study found an estimated cumulative incidence of relapse of 8.7% (95% CI: 1.0–15.9) one year after discontinuation. Factors associated with an increased risk of flare were a treatment duration of less than 1 year and an interval of less than 2 years since the last flare. The low risk of disease reactivation observed in this study suggests that treatment discontinuation could be considered in certain adult patients with MOGAD.
Boudot de la Motte M, Gavoille A, Papeix C, Audoin B, Ayrignac X, Bourre B, Ciron J, Cohen M, Collongues N, Laplaud DA, Maillart E, Michel L, Pique J, Ruet A, Thouvenot E, Zephir H, Aboab J, Moreau T, Mathey G, Froment C, Mélé N, Casez O, Branger P, Kerschen P, Al Khedr A, Maurousset A, Berger E, Moulin M, Clavelou P, Lommers E, Sarov M, Cantagrel P, Megherbi H, Hankiewicz K, Ahle G, Magy L, Giannesini C, Cabasson S, Tourniaire P, Montcuquet A, Creange A, Pegat B, Delpont B, Casey R, Bonjour M, Benyahya L, Deschamps R, Marignier R; NOMADMUS group. Treatment Discontinuation in Patients With Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease. JAMA Neurol. 2026 May 1;83(5):490-498. doi: 10.1001/jamaneurol.2026.0268. PMID: 41870439.
