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Laboratory biomarkers have the potential to predict disease course and activity, thus informing prompt therapeutic decisions to minimise relapse-associated disability accrual.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>This systematic review with meta-analysis was registered in PROSPERO (CRD42024554429). MEDLINE, Embase and Scopus databases were searched. Random-effects or mixed-effects modelling was performed and OR or HR with 95% CIs reported.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>106 studies with \u22651710 individuals were included. A relapsing course was associated with persistent seropositivity on serial samples collected \u22653 months apart (OR 2.7 (95% CI 1.8 to 4.0), p&lt;0.0001), lower likelihood of seroreversion to negative status (HR 0.19 (95% CI 0.14 to 0.26), p&lt;0.0001) and delayed seroreversion compared with monophasic participants (median 19 years vs 2.5 years, p&lt;0.0001). Acute disseminated encephalomyelitis was associated with a non-relapsing course (OR 0.049 (95% CI 0.0029 to 0.84), p=0.037). Serum MOG-IgG titre\u2014negative, low positive or clear positive\u2014discriminated disease state: attack was associated with clear positive titre (OR 3.6 (95% CI 2.6 to 5.0), p&lt;0.0001), but not negative titre (OR 0.073 (95% CI 0.028 to 0.19), p&lt;0.0001). Cerebrospinal fluid (CSF) leucocytosis (\u22655\u2009cells\/\u00b5L) was associated with attack (OR 3.1 (95% CI 1.7 to 5.9), p=0.0004). Neither serum glial fibrillary acidic protein nor neurofilament light chain correlated with disease activity. Novel biomarkers of disease course and activity have also been assessed qualitatively.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>MOG-IgG serostatus and titre and CSF leucocytosis are biomarkers of disease course and activity. The findings provide rationale for serial serum MOG-IgG testing at an interval of 3\u20136\u2009months in the first 12 months of disease to assist in relapse risk stratification.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>PROSPERO registration number<\/jats:title>\n                  <jats:p>CRD42024554429.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/jnnp-2025-337039","type":"journal-article","created":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T08:35:37Z","timestamp":1759307737000},"page":"jnnp-2025-337039","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Biomarkers to predict relapse in myelin oligodendrocyte glycoprotein antibody-associated disease: a systematic review and meta-analysis"],"prefix":"10.1136","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-5322-3924","authenticated-orcid":false,"given":"Jane","family":"Andersen","sequence":"first","affiliation":[{"name":"Kids Neuroscience Centre, Kids Research at the Children\u2019s Hospital at Westmead, Sydney, NSW, Australia"},{"name":"Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6452-6229","authenticated-orcid":false,"given":"Benjamin Peter","family":"Trewin","sequence":"additional","affiliation":[{"name":"Kids Neuroscience Centre, Kids Research at the Children\u2019s Hospital at Westmead, Sydney, NSW, Australia"},{"name":"Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2495-1826","authenticated-orcid":false,"given":"Russell C","family":"Dale","sequence":"additional","affiliation":[{"name":"Kids Neuroscience Centre, Kids Research at the Children\u2019s Hospital at Westmead, Sydney, NSW, Australia"},{"name":"Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia"},{"name":"Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0294-9768","authenticated-orcid":false,"given":"Sudarshini","family":"Ramanathan","sequence":"additional","affiliation":[{"name":"Kids Neuroscience Centre, Kids Research at the Children\u2019s Hospital at Westmead, Sydney, NSW, Australia"},{"name":"Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia"},{"name":"Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia"},{"name":"Department of Neurology, Concord Hospital, Concord, NSW, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7025-2276","authenticated-orcid":false,"given":"Fabienne","family":"Brilot","sequence":"additional","affiliation":[{"name":"Kids Neuroscience Centre, Kids Research at the Children\u2019s Hospital at Westmead, Sydney, NSW, Australia"},{"name":"Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia"},{"name":"Faculty of Medicine and Health, School of Medical Sciences, The University of Sydney, Sydney, NSW, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,10,1]]},"reference":[{"key":"2025100101351754000_jnnp-2025-337039v1.1","doi-asserted-by":"publisher","DOI":"10.1016\/s1474-4422(22)00431-8"},{"key":"2025100101351754000_jnnp-2025-337039v1.2","doi-asserted-by":"crossref","DOI":"10.1016\/j.xcrm.2022.100913","article-title":"Humoral signatures of MOG-antibody-associated disease track with age and disease activity","volume":"4","author":"Spatola","year":"2023","journal-title":"Cell Rep Med"},{"key":"2025100101351754000_jnnp-2025-337039v1.3","doi-asserted-by":"crossref","DOI":"10.1016\/j.autrev.2024.103693","article-title":"MOGAD: A comprehensive review of clinicoradiological features, therapy and outcomes in 4699 patients globally","volume":"24","author":"Trewin","year":"2025","journal-title":"Autoimmun Rev"},{"key":"2025100101351754000_jnnp-2025-337039v1.4","doi-asserted-by":"crossref","unstructured":"Ramanathan S , Mohammad S , Tantsis E , et al . 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