한빛사논문
- 조회257
Young Nam Kwon 1,2, Boram Kim 3, Jun-Soon Kim 4, Kyung Seok Park 4, Da-Young Seo 5, Hyunjin Kim 5, Eun-Jae Lee 5, Young-Min Lim 5, Hyunjin Ju 6, Yeon Hak Chung 7, Ju-Hong Min 8, Tai-Seung Nam 9, Sooyoung Kim 10, Eunhee Sohn 10, Kyong Jin Shin 11, Jin Myoung Seok 12, Sunyoung Kim 13, Jong Seok Bae 14, Sukyoon Lee 15, Seong-Il Oh 16, Yu Jin Jung 17, Jinseok Park 18, Seung Hyun Kim 18, Ki Hoon Kim 19,20, Ho Jin Kim 19, Jae Ho Jung 21, Seong-Joon Kim 21, Seung Woo Kim 1, Myoung-Jin Jang 22, Jung-Joon Sung 3, Patrick Waters 23, Ha Young Shin 1, Sung-Min Kim 2,3
1Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
2Biomedical Research Institute, Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea.
3Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
4Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Gyeonggi-do, Republic of Korea.
5Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
6Department of Neurology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea.
7Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
8Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
9Department of Neurology, Chonnam National University Medical School, Gwangju, Republic of Korea.
10Department of Neurology, Chungnam National University College of Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea.
11Department of Neurology, Haeundae-Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea.
12Department of Neurology, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Republic of Korea.
13Department of Neurology, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Republic of Korea.
14Department of Neurology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea.
15Department of Neurology, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea.
16Department of Neurology, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Republic of Korea.
17Department of Neurology, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
18Department of Neurology, College of Medicine, Hanyang University, Seoul, Republic of Korea.
19Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Republic of Korea.
20Department of Neurology, Inje University Sanggye Paik Hospital, Seoul, Korea.
21Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea.
22Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Republic of Korea.
23Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, United Kingdom.
Corresponding authors: Ha Young Shin, Sung-Min Kim
Abstract
Importance: A proportion of people with myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) have a relapsing disease course and persistent anti-myelin oligodendrocyte glycoprotein immunoglobulin G (MOG-IgG) seropositivity. Few studies have investigated whether treatment of the first MOGAD attack is associated with the long-term disease course and/or MOG-IgG seronegative conversion.
Objective: To investigate the association of time to treat the first acute MOGAD attack with relapse risk and MOG-IgG serostatus.
Design, setting, and participants: This was a retrospective, nationwide, multicenter cohort study involving 14 secondary or tertiary hospitals in South Korea between November 2009 and August 2023. People with adult-onset MOGAD, who either had a relapse or were followed up for more than 12 months after disease onset and had a detailed medical record of their first attack, were included. Individuals were excluded for adolescent-onset MOGAD or short disease duration.
Exposures: Patients were categorized based on the time to treat the first acute MOGAD attack: early (<5 days), intermediate (5-14 days), and late (not treated within 14 days).
Main outcomes and measures: A multivariable analysis for clinical and treatment factors associated with relapsing disease course and/or MOG-IgG seronegative conversion. Further subgroup analyses were conducted among those without long-term nonsteroidal immunosuppressant (NSIS) maintenance treatment.
Results: Among the 315 individuals screened, 75 were excluded. A total of 240 patients (median [IQR] age at onset, 40.4 [28.8-56.1] years; 125 female [52.1%]) with median (IQR) disease duration of 3.07 (1.95-6.15) years were included. A total of 110 of 240 patients (45.8%) relapsed after a median (IQR) of 0.45 (0.18-1.68) years, and 29 of 116 patients (25.0%) experienced a conversion to seronegative MOG-IgG. Both the time to treatment of the first MOGAD attack (late vs early: adjusted hazard ratio [aHR], 2.64; 95% CI, 1.43-4.84; P = .002; intermediate vs early: aHR, 2.02; 95% CI, 1.10-3.74; P = .02) and NSIS maintenance treatment (aHR, 0.24; 95% CI, 0.14-0.42; P < .001) were independently associated with the risk of relapse. In a subgroup without NSIS maintenance, the time to treat of the first MOGAD attack was still associated with higher risk of relapse (late vs early: aHR, 3.51; 95% CI, 1.64-7.50; P = .001; intermediate vs early: aHR, 2.68; 95% CI, 1.23-5.85; P = .01). Lastly, the time to treat of the first MOGAD attack was also associated with MOG-IgG seronegative conversion (early vs late: adjusted odds ratio, 7.04; 95% CI, 1.58-31.41; P = .01), whereas NSIS maintenance treatment was not.
Conclusions and relevance: Results of this cohort study suggest that early treatment of the first acute MOGAD attack was associated with a reduction in the proportion of relapsing disease course and an increase in the likelihood of MOG-IgG seronegative conversion. These data suggest that timing of acute phase treatment for the first MOGAD attack can be associated with the long-term prognosis and autoimmune status of patients.
논문정보
- Research article
- 2024년 10월 (BRIC 등록일 2024-10-28)
- 국내(교신)+국외 연구진
- 의약학 > 신경의학
관련 웨비나
![다발성경화증, 시신경척수염, 그리고 신규 신경면역질환인 MOG항체 질환 [JAMA Neurol.]](/upload/board/files/onseminar/thumb/thumb_0000828.png)
학술웨비나
다발성경화증, 시신경척수염, 그리고 신규 신경면역질환인 MOG항체 질환 [JAMA Neurol.] 다발성경화증(multiple sclerosis, MS), 시신경척수염(neuromyelitis optica, NMO), 그리고 MOG항체 질환 (MOG-antibody associated disease)는 신경계 자가면역질환으로 해외 뿐 아니라 국내에서도 그 유병율/발병율이 빠르게 증가하고 있습니다. 그 중에서도 MOG항체 질환은 중추신경계에만 존재하는 myelin oligodendrocyte glycoprotein (MOG)에 대한 자가면역 기전으로 만성적인 시신경염, 뇌염, 그리고 척수염이 반복되는 질환입니다. 최근 국내에서도 이러한 신경면역질환에 대한 중계/임상연구가 활발해지고 있으나 아직 기초-임상 간의 활발한 협력 연구는 충분하지 않습니다. 이에 최근 저희 연구팀 (SNUH Neuroimmunology Group)의 임상/중개 연구 결과를 MOG-antibody associated disease에 초점을 맞추어 소개하고 향후 국내 여러 기초 연구자분들과 협업을 할 수 있는 기회를 도모하고자 합니다.- 김성민(서울대학교 의과대학)
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