Patients who test positive for anti-myelin oligodendrocyte glycoprotein antibody (anti-MOG-Ab) present with a diversity of clinical and radiologic features, including manifestations suggestive of neuromyelitis optica spectrum disorder, as well as variability regarding disease course and response to disease-modifying therapies, according to study results published in Multiple Sclerosis and Related Disorders.
A total of 184 patients tested for anti-MOG-Ab at a highly specialized Danish multiple sclerosis (MS) center were included in the cross-sectional study. Patients were divided into 2 groups: suggestive of neuromyelitis optica spectrum disorder and suggestive of MS, according to first clinical manifestation. A second categorization of patients treated for MS at time of MOG-Ab testing further divided patients into 2 additional groups: MS/clinically isolated syndrome with typical features and MS/clinically isolated syndrome with atypical features. All groups were also subdivided according to response to disease-modifying therapy.
In the entire cohort, only 4.4% (n=8) of cases of MOG-Ab positivity were found, all of which presented with manifestations suggestive of neuromyelitis optica spectrum disorder. Despite these findings, there was substantial variability in disease course and therapy response among the MOG-Ab-positive cases. One patient with MOG-Ab positivity had chronic relapsing inflammatory optic neuropathy and responded only to infliximab therapy. Only 3% (n=4) of patients with a positive anti-MOG-Ab test result demonstrated atypical features; these patients also demonstrated poor response to disease-modifying therapies.
Limitations of the analysis include the small number of patients who tested positive for MOG-Ab and the potential limited generalizability of the findings because of the inclusion of only patients presenting to a Danish MS center.
“Caution should be exerted in MS with atypical features and poor treatment response,” the investigators wrote after the discussion of their findings, “and MOG-Ab testing should be considered in such cases.”
Papp V, Langkilde AR, Blinkenberg M, Schreiber K, Jensen PEH, Sellebjerg F. Clinical utility of anti-MOG antibody testing in a Danish cohort. Mult Scler Relat Disord. 2018;26:61-67.