Time to Disability Milestones and Annualized Relapse Rates in NMOSD and MOGAD

Ankelien Duchow, Judith Bellmann-Strobl, Tim Friede, Orhan Aktas, Klemens Angstwurm, Ilya Ayzenberg, Achim Berthele, Eva Dawin, Daniel Engels, Katinka Fischer, Martina Flaskamp, Katrin Giglhuber, Matthias Grothe, Joachim Havla, Martin W. Hümmert, Sven Jarius, Matthias Kaste, Peter Kern, Ingo Kleiter, Luisa KlotzMirjam Korporal-Kuhnke, Markus Kraemer, Markus Krumbholz, Tania Kümpfel, Lisa Lohmann, Marius Ringelstein, Paulus Rommer, Patrick Schindler, Charlotte Schubert, Carolin Schwake, Makbule Senel, Florian Then Bergh, Daria Tkachenko, Hayrettin Tumani, Corinna Trebst, Ioannis Vardakas, Annette Walter, Clemens Warnke, Martin S. Weber, Jonathan Wickel, Brigitte Wildemann, Alexander Winkelmann, Friedemann Paul, Jan Patrick Stellmann, Vivien Häußler

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


Objective: To investigate accumulation of disability in neuromyelitis optica spectrum disorder (NMOSD) and myelin oligodendrocyte glycoprotein-antibody-associated disease (MOGAD) in a changing treatment landscape. We aimed to identify risk factors for the development of disability milestones in relation to disease duration, number of attacks, and age. Methods: We analyzed data from individuals with NMOSD and MOGAD from the German Neuromyelitis Optica Study Group registry. Applying survival analyses, we estimated risk factors and computed time to disability milestones as defined by the Expanded Disability Status Score (EDSS). Results: We included 483 patients: 298 AQP4-IgG+ NMOSD, 52 AQP4-IgG/MOG-IgG NMOSD patients, and 133 patients with MOGAD. Despite comparable annualized attack rates, disability milestones occurred earlier and after less attacks in NMOSD patients than MOGAD patients (median time to EDSS 3: AQP4-IgG+ NMOSD 7.7 (95% CI 6.6–9.6) years, AQP4-IgG/MOG-IgG NMOSD 8.7) years, MOGAD 14.1 (95% CI 10.4–27.6) years; EDSS 4: 11.9 (95% CI 9.7–14.7), 11.6 (95% lower CI 7.6) and 20.4 (95% lower CI 14.1) years; EDSS 6: 20.1 (95% CI 16.5–32.1), 20.7 (95% lower CI 11.6), and 37.3 (95% lower CI 29.4) years; and EDSS 7: 34.2 (95% lower CI 31.1) for AQP4-IgG+ NMOSD). Higher age at onset increased the risk for all disability milestones, while risk of disability decreased over time. Interpretation: AQP4-IgG+ NMOSD, AQP4-IgG/MOG-IgG NMOSD, and MOGAD patients show distinctive relapse-associated disability progression, with MOGAD having a less severe disease course. Investigator-initiated research has led to increasing awareness and improved treatment strategies appearing to ameliorate disease outcomes for NMOSD and MOGAD. ANN NEUROL 2024;95:720–732.

Original languageEnglish
Pages (from-to)720-732
Number of pages13
JournalAnnals of Neurology
Issue number4
StatePublished - Apr 2024
Externally publishedYes


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