Evidence map›Paper›PMID 29142145›Full record

ArticleJournal of neurology, neurosurgery, and psychiatry2018

Clinical course, therapeutic responses and outcomes in relapsing MOG antibody-associated demyelination.

Sudarshini Ramanathan, Shekeeb Mohammad, Esther Tantsis, Tina Kim Nguyen, Vera Merheb, Victor S C Fung, Owen Bruce White, Simon Broadley, Jeannette Lechner-Scott, Steve Vucic and 6 more

Open access · hybridAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of neurology, neurosurgery, and psychiatry, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 246 papers, 7 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
246citing papers in PubMed, 7 pooled it
34.8field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

246 citing papers in PubMed, 7 syntheses or guidelines pooled it, 553 citations in OpenAlex.

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186 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

16 authors at 4 institutions in 1 country.

Sudarshini RamanathanBrain Autoimmunity Group, Institute for Neuroscience and Muscle Research, The Kids Research Institute at the Children's Hospital, Westmead, New South Wales, Australia.
Shekeeb MohammadBrain Autoimmunity Group, Institute for Neuroscience and Muscle Research, The Kids Research Institute at the Children's Hospital, Westmead, New South Wales, Australia.
Esther TantsisBrain Autoimmunity Group, Institute for Neuroscience and Muscle Research, The Kids Research Institute at the Children's Hospital, Westmead, New South Wales, Australia.
Tina Kim NguyenBrain Autoimmunity Group, Institute for Neuroscience and Muscle Research, The Kids Research Institute at the Children's Hospital, Westmead, New South Wales, Australia.
Vera MerhebBrain Autoimmunity Group, Institute for Neuroscience and Muscle Research, The Kids Research Institute at the Children's Hospital, Westmead, New South Wales, Australia.
Victor S C FungDepartment of Neurology, Westmead Hospital, Westmead, New South Wales, Australia.
Owen Bruce WhiteOcular Motor Research Laboratory, University of Melbourne, Melbourne, Victoria, Australia.
Simon BroadleySchool of Medicine, Griffith University, Gold Coast, Queensland, Australia.
Jeannette Lechner-ScottDepartment of Neurology, John Hunter Hospital, Newcastle, New South Wales, Australia.
Steve VucicDepartment of Neurology, Westmead Hospital, Westmead, New South Wales, Australia.
Andrew P D HendersonDepartment of Neurology, Westmead Hospital, Westmead, New South Wales, Australia.
Michael Harry BarnettBrain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia.ORCID 0000-0002-2156-8864
Stephen W ReddelBrain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia.
Fabienne BrilotBrain Autoimmunity Group, Institute for Neuroscience and Muscle Research, The Kids Research Institute at the Children's Hospital, Westmead, New South Wales, Australia.
Russell C DaleTY Nelson Department of Neurology and Neurosurgery, Children's Hospital, Westmead, New South Wales, Australia.
Australasian and New Zealand MOG Study Group
The University of Sydney · AUGriffith University · AUJohn Hunter Hospital · AUThe Royal Melbourne Hospital · AU

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveWe characterised the clinical course, treatment and outcomes in 59 patients with relapsing myelin oligodendrocyte glycoprotein (MOG) antibody-associated demyelination.

methodsWe evaluated clinical phenotypes, annualised relapse rates (ARR) prior and on immunotherapy and Expanded Disability Status Scale (EDSS), in 218 demyelinating episodes from 33 paediatric and 26 adult patients.

resultsThe most common initial presentation in the cohort was optic neuritis (ON) in 54% (bilateral (BON) 32%, unilateral (UON) 22%), followed by acute disseminated encephalomyelitis (ADEM) (20%), which occurred exclusively in children. ON was the dominant phenotype (UON 35%, BON 19%) of all clinical episodes. 109/226 (48%) MRIs had no brain lesions. Patients were steroid responsive, but 70% of episodes treated with oral prednisone relapsed, particularly at doses <10 mg daily or within 2 months of cessation. Immunotherapy, including maintenance prednisone (P=0.0004), intravenous immunoglobulin, rituximab and mycophenolate, all reduced median ARRs on-treatment. Treatment failure rates were lower in patients on maintenance steroids (5%) compared with non-steroidal maintenance immunotherapy (38%) (P=0.016). 58% of patients experienced residual disability (average follow-up 61 months, visual loss in 24%). Patients with ON were less likely to have sustained disability defined by a final EDSS of ≥2 (OR 0.15, P=0.032), while those who had any myelitis were more likely to have sustained residual deficits (OR 3.56, P=0.077).

conclusionRelapsing MOG antibody-associated demyelination is strongly associated with ON across all age groups and ADEM in children. Patients are highly responsive to steroids, but vulnerable to relapse on steroid reduction and cessation.

Indexed as

AdolescentAdultAgedAutoantibodiesBrainChildChild, PreschoolCohort StudiesDemyelinating Autoimmune Diseases, CNSEncephalomyelitis, Acute DisseminatedFemaleHumansImmunoglobulins, IntravenousImmunologic FactorsImmunosuppressive AgentsImmunotherapyAutoantibodiesImmunoglobulins, IntravenousImmunologic FactorsImmunosuppressive AgentsMycophenolic AcidMyelin-Oligodendrocyte GlycoproteinPrednisoneRituximabacute disseminated encephalomyelitismyelin oligodendrocyte glycoprotein antibodiesoptic neuritisoutcomestherapy

Identifiers

PMID29142145
PMCPMC5800335
OpenAlexW2770558705

What OpenQuestion holds

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LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.