{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T01:29:23Z","timestamp":1791595763730,"version":"4.3.4"},"reference-count":26,"publisher":"American Medical Association (AMA)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Neurol"],"published-print":{"date-parts":[[2026,5,1]]},"abstract":"<jats:sec id=\"ab-noi260009-4\">\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>Therapeutic deescalation strategies are increasingly considered in demyelinating diseases to mitigate the risks associated with prolonged immunosuppression. The impact of treatment discontinuation in myelin oligodendrocyte glycoprotein antibody\u2013associated disease (MOGAD) is not established.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-noi260009-5\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To assess the relapse risk following treatment discontinuation in adult patients with MOGAD and to evaluate factors associated with disease reactivation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-noi260009-6\">\n                    <jats:title>Design, Setting, and Participants<\/jats:title>\n                    <jats:p>This retrospective cohort study including 41 centers was conducted using the French NOMADMUS database. Adult patients with MOGAD diagnosed between January 2013 and April 2024 were included. Data were extracted on July 1, 2024. A total of 1047 patients with MOGAD were screened, and 705 patients fulfilled the inclusion criteria. Among them, 319 (45.2%) received at least 1 maintenance therapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-noi260009-7\">\n                    <jats:title>Exposure<\/jats:title>\n                    <jats:p>All instances of treatment discontinuation were collected and categorized according to their underlying reasons. Only discontinuations that were scheduled or related to adverse events were analyzed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-noi260009-8\">\n                    <jats:title>Main Outcomes and Measures<\/jats:title>\n                    <jats:p>Time to first relapse was estimated using Kaplan-Meier survival curves, and differences between groups were assessed using the log-rank test.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-noi260009-9\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 83 patients (median [IQR] age, 42.7 [28.9-53.3] years; 52 [63.7%] female) discontinued either oral immunosuppressants (azathioprine or mycophenolate mofetil) or rituximab in 60 (72.1%) and 23 (27.7%) individuals, respectively. Discontinuations were scheduled (n\u2009=\u200954 [65.1%]) or related to adverse events (n\u2009=\u200929 [34.9%]). After discontinuation, 7 patients relapsed, with a median (IQR) time to relapse of 0.5 (0.1-1.4) years. The Kaplan-Meier estimated cumulative incidence of relapse at 1 year after discontinuation was 8.7% (95% CI, 1.0-15.9). Severity of relapses was mild, with a median (IQR) change in the Expanded Disability Status Scale score of 0 (0-1) points. Factors associated with an increased relapse risk were a treatment duration of less than 1 year (7 relapses [19.4%] vs 0 relapses; log-rank\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.002) and a time since last relapse of less than 2 years (7 relapses [15.9%] vs 0 relapses; log-rank\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.01).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-noi260009-10\">\n                    <jats:title>Conclusions and Relevance<\/jats:title>\n                    <jats:p>The low risk of disease reactivation found in this study suggests that discontinuing treatment may be considered in selected adult patients with MOGAD. Future clinical trials are necessary to confirm these results and establish guidelines in this situation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1001\/jamaneurol.2026.0268","type":"journal-article","created":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T15:30:26Z","timestamp":1774279826000},"page":"490","source":"Crossref","is-referenced-by-count":7,"title":["Treatment Discontinuation in Patients With Myelin Oligodendrocyte Glycoprotein Antibody\u2013Associated Disease"],"prefix":"10.1001","volume":"83","author":[{"given":"Marine","family":"Boudot de la Motte","sequence":"first","affiliation":[{"name":"Department of Neurology, Rothschild Foundation Hospital, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antoine","family":"Gavoille","sequence":"additional","affiliation":[{"name":"Department of Neurology, Scl\u00e9rose en Plaques, Pathologie de la My\u00e9line et Neuro-Inflammation and referral center for rare inflammatory disorders of the brain and the spinal cord, Hopital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron, France"},{"name":"Universit\u00e9 de Lyon, Universit\u00e9 Lyon 1, Centre National de la Recherche Scientifique, Laboratoire de Biom\u00e9trie et Biologie \u00c9volutive Unit\u00e9 Mixte de Recherche 5558, Villeurbanne, France"},{"name":"Service de Biostatistique-Bioinformatique, Hospices Civils de Lyon, Lyon, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline","family":"Papeix","sequence":"additional","affiliation":[{"name":"Department of Neurology, Rothschild Foundation Hospital, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bertrand","family":"Audoin","sequence":"additional","affiliation":[{"name":"Department of Neurology, P\u00f4le de Neurosciences Cliniques, Assistance Publique H\u00f4pitaux de Marseille, Aix Marseille University, H\u00f4pital de la Timone, Marseille, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xavier","family":"Ayrignac","sequence":"additional","affiliation":[{"name":"Centre de Ressources et de Comp\u00e9tences Scl\u00e9rose en plaques, Centre de R\u00e9f\u00e9rence Maladies Rares Leukofrance, Department of Neurology, Institut des Neurosciences de Montpellier\/U1298, Gui de Chauliac Hospital, University Hospital of Montpellier, Montpellier, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bertrand","family":"Bourre","sequence":"additional","affiliation":[{"name":"Department of Neurology, University Hospital of Rouen, Rouen, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Ciron","sequence":"additional","affiliation":[{"name":"Department of Neurology, CRC-SEP, University Hospital of Toulouse, Toulouse, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mikael","family":"Cohen","sequence":"additional","affiliation":[{"name":"CRCSEP Neurologie Pasteur 2, Unit\u00e9 de Recherche Clinique C\u00f4te d\u2019Azur, University Hospital of Nice, Universit\u00e9 Cote d\u2019Azur, Nice, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas","family":"Collongues","sequence":"additional","affiliation":[{"name":"Department of Neurology, University Hospital of Strasbourg, Strasbourg, France"},{"name":"Center for Clinical Investigation, Institut national de la sant\u00e9 et de la recherche m\u00e9dicale U1434, Strasbourg, France. Biopathology of myelin, neuroprotection and therapeutic strategy, Institut national de la sant\u00e9 et de la recherche m\u00e9dicale U1119, Strasbourg, France"},{"name":"Department of Pharmacology, Addictology, Toxicology and Therapeutics, Strasbourg University, Strasbourg, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David Axel","family":"Laplaud","sequence":"additional","affiliation":[{"name":"Department of Neurology, Center for Research in Transplantation and Translational Immunology-Institut national de la sant\u00e9 et de la recherche m\u00e9dicale U1064, Centre d\u2019investigations cliniques 1314, Nantes Universit\u00e9, University Hospital of Nantes, Nantes, France,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabeth","family":"Maillart","sequence":"additional","affiliation":[{"name":"Department of Neurology, AP-HP, Piti\u00e9-Salp\u00eatri\u00e8re Hospital, Centre de r\u00e9f\u00e9rence des maladies inflammatoires rares du cerveau et de la moelle, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laure","family":"Michel","sequence":"additional","affiliation":[{"name":"Department of Neurology, Institut national de la sant\u00e9 et de la recherche m\u00e9dicale Unit\u00e9 Mixte de Recherche 1236, Universit\u00e9 de Rennes 1, University Hospital of Rennes, Rennes, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie","family":"Pique","sequence":"additional","affiliation":[{"name":"Department of Neurology, Scl\u00e9rose en Plaques, Pathologie de la My\u00e9line et Neuro-Inflammation and referral center for rare inflammatory disorders of the brain and the spinal cord, Hopital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aurelie","family":"Ruet","sequence":"additional","affiliation":[{"name":"Department of Neurology et maladies inflammatoires du syst\u00e8me nerveux central, Centre de Ressources et de Comp\u00e9tences Scl\u00e9rose en plaques, centre de comp\u00e9tences maladies inflammatoires rares du cerveau et de la moelle, University Hospital of Bordeaux, Bordeaux, France"},{"name":"Institut national de la sant\u00e9 et de la recherche m\u00e9dicale U1215, Neurocentre Magendie, Universit\u00e9 de Bordeaux, Bordeaux, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Thouvenot","sequence":"additional","affiliation":[{"name":"Department of Neurology, University Hospital of Nimes, Nimes, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H\u00e9l\u00e8ne","family":"Zephir","sequence":"additional","affiliation":[{"name":"Centre de Ressources et de Comp\u00e9tences Scl\u00e9rose en plaques, Department of Neurology, U1172, University Hospital of Lille, Lille, 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University, Lyon Neuroscience Research Center Centre de Recherche en Neurosciences de Lyon U1028 Unit\u00e9 Mixte de Recherche 5292, Int\u00e9gration Multisensorielle, Perception, Action et CogniTion F-69500, Neurological Hospital of Lyon, Lyon, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas","family":"M\u00e9l\u00e9","sequence":"additional","affiliation":[{"name":"Department of Neurology, Sainte-Anne Hospital, Groupe hospitalo-universitaire Paris Psychiatrie et Neurosciences, Paris Cit\u00e9 University, Institut national de la sant\u00e9 et de la recherche m\u00e9dicale 1266, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivier","family":"Casez","sequence":"additional","affiliation":[{"name":"Neurology Multiple Sclerosis Clinic Grenoble, Grenoble Alpes University Hospital, Grenoble, 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France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Berger","sequence":"additional","affiliation":[{"name":"Department of Neurology, University Hospital of Besancon, Besancon, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maximilien","family":"Moulin","sequence":"additional","affiliation":[{"name":"Department of Neurology, University Hospital of Reims, Reims, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierre","family":"Clavelou","sequence":"additional","affiliation":[{"name":"Department of Neurology, and Institut national de la sant\u00e9 et de la recherche m\u00e9dicale NeuroDol U1107, Centre de Ressources et de Comp\u00e9tences Scl\u00e9rose en plaques Auvergne, CHU Clermont-Ferrand, Clermont-Ferrand, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emilie","family":"Lommers","sequence":"additional","affiliation":[{"name":"Neuroimmunology Unit, Neurology Department, 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France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastien","family":"Cabasson","sequence":"additional","affiliation":[{"name":"Department of Child Neurology and Child Intensive Care Unit, Hospital of Pau, Pau, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia","family":"Tourniaire","sequence":"additional","affiliation":[{"name":"Department of Neurology, H\u00f4pital Henri Duffaut, Avignon, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexis","family":"Montcuquet","sequence":"additional","affiliation":[{"name":"Department of Neurology, Hospital of Brive, Brive la Gaillarde, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alain","family":"Creange","sequence":"additional","affiliation":[{"name":"Department of Neurology, H\u00f4pital Henri Mondor, Assistance Publique H\u00f4pitaux de Paris, Universit\u00e9 Paris-Est Cr\u00e9teil, Cr\u00e9teil, 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