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Journal article
Oral corticosteroid dosage and tape duration at onset in myelin oligodendrocyte glycoprotein antibody-associated disease influences time to first relapse
Journal of neurology, neurosurgery and psychiatry, Online First
2024
Abstract
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.
Details
- Title
- Oral corticosteroid dosage and tape duration at onset in myelin oligodendrocyte glycoprotein antibody-associated disease influences time to first relapse
- Authors/Creators
- Benjamin P Trewin - The University of SydneyRussell C Dale - Children's Hospital at WestmeadJessica Qiu - The University of SydneyMelissa Chu - The Royal Melbourne HospitalNiroshan Jeyakumar - The University of SydneyFionna Dela Cruz - The Royal Melbourne HospitalJane Andersen - The University of SydneyPakeeran Siriratnam - Monash UniversityKit Kwan M Ma - The Royal Melbourne HospitalTodd A Hardy - Concord Repatriation General HospitalAnneke van der Walt - The Alfred HospitalJeanette Lechner-Scott - University of Newcastle AustraliaHelmut Butzkueven - Monash UniversitySimon A Broadley - Griffith UniversityMichael H Barnett - The University of SydneyStephen W Reddel - Concord Repatriation General HospitalFabienne Brilot - The University of SydneyTomas Kalincik - The Royal Melbourne HospitalSudarshini Ramanathan - The University of SydneyRobert AdamIan AndrewsJayne AntonyPatrick AouadMonica BadveJoshua BartonHeidi BeadnallStefan BlumMichael BoggildDavid A BrownJim BurrowKatherine BuzzardAnn ByeAnita CairnsSophie CalvertShabeed ChelakkadanDamian R ClarkMarzena J Fabis-PedriniDeborah FieldAnthony FokClare L FraserVictor SC FungJustin GarberSerge GearaDeepak GillSachin GuptaSimon HawkeAndrew PD HendersonNevin A JohnDean L JonesHannah F JonesAllan KermodeMatthew KiernanTrevor KilpatrickAndrew J KornbergMitchell LawlorFiona XZ LeeRichard J LeventerVivien LiSimon LingGanesha LiyanageJoseph A LopezStephen MaloneMark P MarriotPamela McCombeAlan McDougallManoj P MenezesVera MerhebChristina MiteffMastura MonifGopinath Musuwadi SubramanianAi-Lan NguyenGina O’GradyJohn O’NeillRobert OuvrierMark PaineJohn ParrattSekhar PillaiJane ProsserSean DS RimintonIzanne RoosJennifer SandbachIngrid E SchefferUbaid ShahNeil ShueyAdriane SinclairMark SleeClaire G SpoonerIan SuttonSanjay SwaminathanEsther TantsisJames ThomasTerrence ThomasJulia ThompsonChristopher TroedsonSteve VucicJustine WangTyson WareRichard WebsterMing Wei LinOwen WhiteWei YehCon YiannikasEppie M YiuMichael Zong
- Publication Details
- Journal of neurology, neurosurgery and psychiatry, Online First
- Publisher
- BMJ Publishing Group Ltd
- Grant note
- N/A / University of Sydney Ramanathan - SOAR Prize and Rewarding Research Success Grants, Trewin - RTP Scholarship N/A / Royal Australasian College of Physicians Ramanathan Research Establishment Fellowship Ramanathan Early Career Fellowship GNT1141169; Ramanathan Investigator Grant GNT2008339 / National Health and Medical Research Council (http://dx.doi.org/10.13039/501100000925)
- Identifiers
- 991005665670107891
- Copyright
- © Author(s) (or their employer(s)) 2024.
- Murdoch Affiliation
- Institute for Immunology and Infectious Diseases
- Language
- English
- Resource Type
- Journal article
- Note
- On behalf of the Australasian MOGAD Study Group
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