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. 2026 Mar 23.
doi: 10.1001/jamaneurol.2026.0268. Online ahead of print.

Treatment Discontinuation in Patients With Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease

Marine Boudot de la Motte  1 , Antoine Gavoille  2   3   4 , Caroline Papeix  1 , Bertrand Audoin  5 , Xavier Ayrignac  6 , Bertrand Bourre  7 , Jonathan Ciron  8 , Mikael Cohen  9 , Nicolas Collongues  10   11   12 , David Axel Laplaud  13 , Elisabeth Maillart  14 , Laure Michel  15 , Julie Pique  2 , Aurelie Ruet  16   17 , Eric Thouvenot  18 , Hélène Zephir  19 , Jennifer Aboab  20 , Thibault Moreau  21 , Guillaume Mathey  22   23 , Caroline Froment  24 , Nicolas Mélé  25 , Olivier Casez  26 , Pierre Branger  27 , Philippe Kerschen  28 , Abdullatif Al Khedr  29 , Aude Maurousset  30 , Eric Berger  31 , Maximilien Moulin  32 , Pierre Clavelou  33 , Emilie Lommers  34 , Mariana Sarov  35 , Paul Cantagrel  36 , Hana Megherbi  37 , Karolina Hankiewicz  38 , Guido Ahle  39 , Laurent Magy  40 , Claire Giannesini  14 , Sebastien Cabasson  41 , Patricia Tourniaire  42 , Alexis Montcuquet  43 , Alain Creange  44 , Benoit Pegat  45 , Benoit Delpont  46 , Romain Casey  47   48   49 , Maxime Bonjour  3   4 , Lakhdar Benyahya  2 , Romain Deschamps  1 , Romain Marignier  2 ; NOMADMUS group
Collaborators, Affiliations
Free article

Treatment Discontinuation in Patients With Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease

Marine Boudot de la Motte et al. JAMA Neurol. .
Free article

Abstract

Importance: Therapeutic deescalation strategies are increasingly considered in demyelinating diseases to mitigate the risks associated with prolonged immunosuppression. The impact of treatment discontinuation in myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is not established.

Objective: To assess the relapse risk following treatment discontinuation in adult patients with MOGAD and to evaluate factors associated with disease reactivation.

Design, setting, and participants: This retrospective cohort study including 41 centers was conducted using the French NOMADMUS database. Adult patients with MOGAD diagnosed between January 2013 and April 2024 were included. Data were extracted on July 1, 2024. A total of 1047 patients with MOGAD were screened, and 705 patients fulfilled the inclusion criteria. Among them, 319 (45.2%) received at least 1 maintenance therapy.

Exposure: All instances of treatment discontinuation were collected and categorized according to their underlying reasons. Only discontinuations that were scheduled or related to adverse events were analyzed.

Main outcomes and measures: Time to first relapse was estimated using Kaplan-Meier survival curves, and differences between groups were assessed using the log-rank test.

Results: A total of 83 patients (median [IQR] age, 42.7 [28.9-53.3] years; 52 [63.7%] female) discontinued either oral immunosuppressants (azathioprine or mycophenolate mofetil) or rituximab in 60 (72.1%) and 23 (27.7%) individuals, respectively. Discontinuations were scheduled (n = 54 [65.1%]) or related to adverse events (n = 29 [34.9%]). After discontinuation, 7 patients relapsed, with a median (IQR) time to relapse of 0.5 (0.1-1.4) years. The Kaplan-Meier estimated cumulative incidence of relapse at 1 year after discontinuation was 8.7% (95% CI, 1.0-15.9). Severity of relapses was mild, with a median (IQR) change in the Expanded Disability Status Scale score of 0 (0-1) points. Factors associated with an increased relapse risk were a treatment duration of less than 1 year (7 relapses [19.4%] vs 0 relapses; log-rank P = .002) and a time since last relapse of less than 2 years (7 relapses [15.9%] vs 0 relapses; log-rank P = .01).

Conclusions and relevance: The low risk of disease reactivation found in this study suggests that discontinuing treatment may be considered in selected adult patients with MOGAD. Future clinical trials are necessary to confirm these results and establish guidelines in this situation.

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