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Archives: Research Summaries

Long-term Effectiveness and Safety of Rituximab in Neuromyelitis Optica Spectrum Disorder and MOG Antibody Disease

Long-term Effectiveness and Safety of Rituximab in Neuromyelitis Optica Spectrum Disorder and MOG Antibody Disease

Journal: Neurology; August 31, 2022

Author(s): Paula Barreras, Eleni S Vasileiou, Angeliki G Filippatou, Kathryn C Fitzgerald, Michael Levy, Carlos A Pardo, Scott D Newsome, Ellen M Mowry, Peter A Calabresi and Elias S Sotirchos

Long-term effectiveness and safety of Rituximab in NMOSD and MOGAD

Although not an FDA-approved therapy for NMOSD, rituximab is widely used as an off-label therapy for relapse prevention in NMOSD and MOGAD patients. This study evaluated long-term outcomes of rituximab treatment for 111 NMOSD patients who tested positive for antibodies against aquaporin-4 (seropositive patients) and for 23 MOGAD patients. The results show that provided the treatment protocol is followed well, rituximab reduces the annual relapse rate substantially in seropositive NMOSD patients but not as robustly in MOGAD patients. Significant cases of infections were noted among patients, highlighting the need for careful monitoring of infections in patients under rituximab treatment.

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Comparison of live and fixed cell-based assay performance: implications for the diagnosis of MOGAD in a low-middle income country

Comparison of live and fixed cell-based assay performance: implications for the diagnosis of MOGAD in a low-middle income country

Journal: Frontiers in Immunology; August 29, 2023

Author(s): Lekha Pandit, Anitha D’Cunha, Chaithra Malli and Akshatha Sudhir

Comparison of two diagnostic tests for MOGAD in an Indian population

The diagnosis of MOGAD poses many clinical challenges because the disease has many features similar to MS and NMOSD. This study compared two diagnostic techniques for MOGAD – (a) a live cell-based assay (LCBA) that is more expensive and requires more technical skills and infrastructure and a fixed cell-based assay (FCBA) that is commercially developed, cost-effective, and easier to conduct at scale. Whereas some earlier studies have shown that the LBCA is more effective and accurate than the FCBA for MOGA diagnosis, this study showed that the diagnostic value of both assays were similar. In India where this study was done, most patients are uninsured and medical costs are managed out-of-pocket, so these results offer hope for more cost-effective diagnostic screening at scale.

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

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

Journal: JAMA Neurology; May 1, 2022

Author(s): John J Chen, Saif Huda, Yael Hacohen, Michael Levy, Itay Lotan, Adi Wilf-Yarkoni, Hadas Stiebel-Kalish, Mark A Hellmann, Elias S Sotirchos, Amanda D Henderson, Sean J Pittock, M Tariq Bhatti, Eric R Eggenberger, Marie Di Nome, Ho Jin Kim, Su-Hyun Kim, Albert Saiz, Friedemann Paul, Russell C Dale, Sudarshini Ramanathan, Jacqueline Palace, Valentina Camera, Maria Isabel Leite, Byron L Lam, Jeffrey L Bennett, Sara Mariotto, Dave Hodge, Bertrand Audoin, Elisabeth Maillart, Romain Deschamps, Julie Pique, Eoin P Flanagan and Romain Marignier

IVIG for relapse prevention in adult MOGAD patients

In this retrospective study of records of 59 adult patients with MOGAD, long-term IVIG treatment was found to significantly reduce the annual relapse frequency. These results need to be validated in large-scale clinical trials.

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Long-term Outcomes of MOGAD without Chronic Steroid-sparing Immunotherapy: a Multicenter Retrospective Cohort (S40.008)

Long-term Outcomes of MOGAD without Chronic Steroid-sparing Immunotherapy: a Multicenter Retrospective Cohort (S40.008)

Journal: Neurology; April 25, 2023

Author(s): Nanthaya Tisavipat, Adi Wilf-Yarkoni, Eoin Flanagan, Vyanka Redenbaugh, Yoel Schwartzmann, Mark Hellmann, Assaf Tolkovsky, Hadas Stiebel-Kalish, Itay Lotan, Michael Levy, Rebecca Salky, Adi Vaknin-Dembinsky, Esther Ganelin-Cohen, Alfonso Lopez, Sean Pittock and John Chen

Long-term outcomes in MOGAD patients not receiving any immunotherapy apart from steroids

In this retrospective study, medical charts of 55 MOGAD patients were reviewed. The patients included (1) were diagnosed with MOGAD, (2) had visited one of the hospitals participating in the study, and (3) had not been on any immunotherapy other than steroids for at least the 3-year observation period. The results showed that without long-term immunotherapy, some MOGAD patients had relapses, but overall did not have a significant decline in their disability scores or visual acuity.

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Intravenous immunoglobulin treatment for acute attacks in myelin oligodendrocyte glycoprotein antibody disease

Intravenous immunoglobulin treatment for acute attacks in myelin oligodendrocyte glycoprotein antibody disease

Journal: Multiple Sclerosis Journal; July 10, 2023

Author(s): Itay Lotan, John J Chen, Yael Hacohen, Omar Abdel-Mannan, Sara Mariotto, Saif Huda, Emily Gibbons, Adi Wilf-Yarkoni, Mark A Hellmann, Hadas Stiebel-Kalish, Sean J Pittock, Eoin P Flanagan, Negar Molazadeh, Monique Anderson, Rebecca Salky, Gabriela Romanow, Patrick Schindler, Ankelien Solveig Duchow, Friedemann Paul and Michael Levy

Effectiveness of IVIG treatment for acute attacks in MOGAD

In this retrospective study, case details of 39 MOGAD patients (53.8% female, median age 23 years) who had been treated with intravenous immunoglobulins (IVIG) were reviewed to assess the therapeutic benefit of IVIG. The results showed that IVIG treatment improved the patients’ disability scores and visual acuity. IVIG may be an effective treatment option for acute MOGAD attacks. Larger-scale clinical trials are needed to validate these results.

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The treatment of myelin oligodendrocyte glycoprotein antibody disease: a state-of-the-art review

The treatment of myelin oligodendrocyte glycoprotein antibody disease: a state-of-the-art review

Journal: Journal of Neuro-Ophthalmology; September 1, 2022

Author(s): Bart K. Chwalisz and Michael Levy

Acute and long-term treatment of MOGAD

This study reviews previously published studies on acute treatment of MOGAD with corticosteroids and adjunct therapies, such as intravenous immunoglobulin (IVIG) and plasma exchange; discusses the value of prolonged corticosteroid tapering after acute attacks; and summarizes the long-term therapies available for MOGAD, including chronic low-dose corticosteroids, classic antirheumatic immune suppressants, biologic agents, and IVIG. While acute MOGAD attacks are usually treated with high-dose IV corticosteroids, longer oral corticosteroid tapers may prevent rapid relapse. Multiple long-term treatment strategies are being used for recurrent MOGAD, with IVIG emerging as probably the most effective therapy.

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Network meta-analysis of Food and Drug Administration-approved treatment options for adults with aquaporin-4 immunoglobulin G-positive neuromyelitis optica spectrum disorder

Network meta-analysis of Food and Drug Administration-approved treatment options for adults with aquaporin-4 immunoglobulin G-positive neuromyelitis optica spectrum disorder

Journal: Neurology and Therapy; November 13, 2021

Author(s): Dean M. Wingerchuk, Ina Zhang, Adrian Kielhorn, Minying Royston, Michael Levy, Kazuo Fujihara, Ichiro Nakashima, Imran Tanvir, Friedemann Paul, and Sean J. Pittock

Comparison of FDA-approved treatments for NMOSD patients

Many patients with NMOSD produce antibodies against a protein called aquaporin-4 (seropositive patients). This study used prior publications and exiting data to compare three drugs (eculizumab, inebilizumab, and satralizumab) that have been approved by the US Food and Drug Administration for the treatment of seropositive adult patients. While all three drugs are safe and shown to prevent relapses in clinical trials, this study suggests that eculizumab was the most efficacious in preventing relapses when compared with inebilizumab or satralizumab. These findings may help inform decision-making around NMOSD treatment to prevent relapses in seropositive adult patients.

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International consensus diagnostic criteria for neuromyelitis optica spectrum disorders

International consensus diagnostic criteria for neuromyelitis optica spectrum disorders

Journal: Neurology; July 14, 2015

Author(s): Dean M. Wingerchuk, Brenda Banwell, Jeffrey L. Bennett, Philippe Cabre, William Carroll, Tanuja Chitnis, Jérôme de Seze, Kazuo Fujihara, Benjamin Greenberg, Anu Jacob, Sven Jarius, Marco Lana-Peixoto, Michael Levy, Jack H. Simon, Silvia Tenembaum, Anthony L. Traboulsee, Patrick Waters, Kay E. Wellik and Brian G. Weinshenker

Diagnostic criteria for NMOSD

Patients with NMOSD often go several years without an accurate diagnosis. The International Panel for NMO Diagnosis (IPND) was convened to develop consensus diagnostic criteria for NMOSD. Most NMO patients test positive in a blood test for serum antibodies against a protein called aquaporin-4 (seropositive patients), but some do not (seronegative patients). This landmark paper puts forth the IPND diagnostic criteria, which provide a decision-making framework for diagnosis of both seropositive and seronegative patients.

The criteria include specific clinical features that can be determined on clinical examination; specific brain and spinal cord patterns detectable on an MRI; and specific results in blood tests; and red flags that are not typical in NMOSD (indicating a possible alternative diagnosis). Patients seeking a diagnosis may direct their neurologist to this paper and discuss their own case based on these criteria.

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Neuromyelitis optica

Neuromyelitis optica

Journal: Nature Reviews Disease Primers; October 22, 2020

Author(s): Sven Jarius, Friedemann Paul, Brian G. Weinsheinker, Michael Levy, Ho Jin Kim and Brigitte Wildemann

NMOSD overview

This article provides a snapshot overview of NMOSD, how it develops and manifests, which types of people and populations it is more likely to affect, and how it can be diagnosed and managed.

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