- Title
- Oral corticosteroid dosage and tapeduration at onset in myelin oligodendrocyte glycoprotein antibody-associated disease influences time to first relapse
- Creator
- Trewin, Benjamin P.; Dale, Russell C.; van der Walt, Anneke; Lechner-Scott, Jeanette; Butzkueven, Helmut; Broadley, Simon A.; Barnett, Michael H.; Reddel, Stephen W.; Brilot, Fabienne; Kalincik, Tomas; Ramanathan, Sudarshini; Qiu, Jessica; Chu, Melissa; Jeyakumar, Niroshan; Dela Cruz, Fionna; Andersen, Jane; Siriratnam, Pakeeran; Ma, Kit Kwan M.; Hardy, Todd A.
- Relation
- Journal of Neurology, Neurosurgery & Psychiatry Vol. 95, Issue 11, p. 1054-1063
- Publisher Link
- http://dx.doi.org/10.1136/jnnp-2024-333463
- Publisher
- BMJ Group
- Resource Type
- journal article
- Date
- 2024
- Description
- Background: We sought to identify an optimal oral corticosteroid regimen at the onset of myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD), which would delay time to first relapse while minimising cumulative corticosteroid exposure. Methods: In a retrospective multicentre cohort study, Cox proportional hazards models examined the relationship between corticosteroid course as a time-varying covariate and time to first relapse. Simon-Makuch and Kaplan-Meier plots identified an optimal dosing strategy. Results: We evaluated 109 patients (62 female, 57%; 41 paediatric, 38%; median age at onset 26 years, (IQR 8–38); median follow-up 6.2 years (IQR 2.6–9.6)). 76/109 (70%) experienced a relapse (median time to first relapse 13.7 months; 95% CI 8.2 to 37.9). In a multivariable model, higher doses of oral prednisone delayed time to first relapse with an effect estimate of 3.7% (95% CI 0.8% to 6.6%; p=0.014) reduced hazard of relapse for every 1 mg/day dose increment. There was evidence of reduced hazard of relapse for patients dosed ≥12.5 mg/day (HR 0.21, 95% CI 0.07 to 0.6; p=0.0036), corresponding to a 79% reduction in relapse risk. There was evidence of reduced hazard of relapse for those dosed ≥12.5 mg/day for at least 3 months (HR 0.12, 95% CI 0.03 to 0.44; p=0.0012), corresponding to an 88% reduction in relapse risk compared with those never treated in this range. No patient with this recommended dosing at onset experienced a Common Terminology Criteria for Adverse Events grade >3 adverse effect. Conclusions: The optimal dose of 12.5 mg of prednisone daily in adults (0.16 mg/kg/day for children) for a minimum of 3 months at the onset of MOGAD delays time to first relapse.
- Subject
- oral corticosteroid; myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD); dosing; relapse
- Identifier
- http://hdl.handle.net/1959.13/1514022
- Identifier
- uon:56801
- Identifier
- ISSN:0022-3050
- Rights
- "© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made."
- Language
- eng
- Full Text
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