RT Journal Article
SR Electronic
T1 Oral corticosteroid dosage and taper duration at onset in myelin oligodendrocyte glycoprotein antibody-associated disease influences time to first relapse
JF Journal of Neurology, Neurosurgery & Psychiatry
JO J Neurol Neurosurg Psychiatry
FD BMJ Publishing Group Ltd
SP 1054
OP 1063
DO 10.1136/jnnp-2024-333463
VO 95
IS 11
A1 Trewin, Benjamin P
A1 Dale, Russell C
A1 Qiu, Jessica
A1 Chu, Melissa
A1 Jeyakumar, Niroshan
A1 Dela Cruz, Fionna
A1 Andersen, Jane
A1 Siriratnam, Pakeeran
A1 Ma, Kit Kwan M
A1 Hardy, Todd A
A1 van der Walt, Anneke
A1 Lechner-Scott, Jeanette
A1 Butzkueven, Helmut
A1 Broadley, Simon A
A1 Barnett, Michael H
A1 Reddel, Stephen W
A1 Brilot, Fabienne
A1 Kalincik, Tomas
A1 Ramanathan, Sudarshini
A1 
YR 2024
UL http://jnnp.bmj.com/content/95/11/1054.abstract
AB 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.Data are available on reasonable request. Anonymised data and datasets that support the findings of the current study are available from the corresponding author on reasonable request.