Comorbidities Are Associated With Unfavorable Outcome in Aquaporin-4 Antibody Positive Neuromyelitis Optica Spectrum Disorders and Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease: Exploratory Study From the CROCTINO Cohort.

Journal: European Journal Of Neurology

Published: January 12, 2025

Abstract

Background: Comorbidities occur in aquaporin-4 antibody-positive neuromyelitis optica spectrum disorder (AQP4-NMOSD), myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD), and double seronegative NMOSD (DN-NMOSD), potentially contributing to a less favorable disease course.

Objective: To characterize comorbidities in AQP4-NMOSD, MOGAD, and DN-NMOSD and assess their association with optic neuritis (ON) outcomes by optical coherence tomography (OCT) in AQP4-NMOSD.

Methods: Four hundred and forty-two participants from the CROCTINO cohort were evaluated for comorbidities.

Results: In AQP4-NMOSD patients (n = 360), 43.5% (n = 161) had comorbidities, equally divided between single and multiple. In MOGAD (n = 49), 40.8% had comorbidities, with 75% (n = 15) single and 25% (n = 5) multiple. In DN-NMOSD (n = 33), 36.4% (n = 12) had comorbidities equally split. AQP4-NMOSD patients had more multiple comorbidities (50%, n = 81/161) than MOGAD (25%, n = 5/20, p = 0.03) and more autoimmune disorders (AID) (40.4%, n = 65) than MOGAD (20%, n = 4, p = 0.09) and DN-NMOSD (none, p = 0.004). Cardiovascular comorbidities and related risk factors (CVC/RF) occurred in 34.8% (n = 56) of AQP4-NMOSD, 50% (n = 10) of MOGAD, and 33.3% (n = 4) of DN-NMOSD. Expanded Disability Status Scale was higher in MOGAD (3.0 vs. 2.0, p = 0.006) and DN-NMOSD (5.0 vs. 2.0, p = 0.008) with comorbidities. AQP4-NMOSD patients with CVC/RF had higher ON relapse rates than those with AID (1.06 ± 3.33 vs. 0.49 ± 0.98, p < 0.001). OCT revealed reduced inner nuclear layer thickness in AQP4-NMOSD with comorbidities compared to non-comorbidity (B = -1.52, p = 0.047), more pronounced with CVC/RF (B = -2.96, p = 0.009).

Conclusions: Comorbidities are frequent in AQP4-NMOSD and MOGAD and are associated with ON frequency and disability. These findings highlight the need for proactive comorbidity management to improve patient care.

Authors

Sara Samadzadeh, Frederike Oertel, Hadi Salih, Ting-yi Lin, Seyedamirhosein Motamedi, Claudia Chien, Lawrence Cook, Marco Lana Peixoto, Mariana Fontenelle, Ho Kim, Jae-won Hyun, Su-kyung Jung, Jaqueline Palace, Adriana Roca Fernandez, Maria Leite, Srilakshmi Sharma, Fereshteh Ashtari, Rahele Kafieh, Alireza Dehghani, Mohsen Pourazizi, Lekha Pandit, Anitha Dcunha, Orhan Aktas, Marius Ringelstein, Philipp Albrecht, Eugene May, Caryl Tongco, Letizia Leocani, Marco Pisa, Marta Radaelli, Bernardo Sánchez Dalmau, Elena Martinez Lapiscina, Hadas Stiebel Kalish, Mark Hellmann, Itay Lotan, Sasitorn Siritho, Jérôme De Seze, Thomas Senger, Joachim Havla, Romain Marignier, Caroline Tilikete, Alvaro Cobo Calvo, Denis Bichuetti, Ivan Tavares, Kerstin Soelberg, Ayse Altintas, Rengin Yildirim, Uygur Tanriverdi, Anu Jacob, Saif Huda, Zoe Rimler, Allyson Reid, Yang Mao Draayer, Pablo Villoslada, Ibis De Castillo, Ari Green, Axel Petzold, Michael Yeaman, Terry Smith, Alexander Brandt, Hanna Zimmermann, Friedemann Paul, Nasrin Asgari

Relevant Conditions

Transverse Myelitis, Optic Neuritis, Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease, Neuromyelitis Optica

Comorbidities Are Associated With Unfavorable Outcome in Aquaporin-4 Antibody Positive Neuromyelitis Optica Spectrum Disorders and Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease: Exploratory Study From the CROCTINO Cohort.

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