The impact of autoimmune comorbidities on the onset attack recovery in adults with AQP4-NMOSD and MOGAD

BACKGROUND: Aquaporin-4 neuromyelitis optica spectrum disorder (AQP4-NMOSD) often coexists with other autoimmune diseases (AIDs), whereas such comorbidities are less common in myelin oligodendrocyte glycoprotein antibody disease (MOGAD). This study investigates the impact of additional AIDs on early relapse recovery and disability in patients with AQP4-NMOSD and MOGAD. METHODS: This retrospective study included patients aged > 16 years with AQP4-NMOSD (n = 175) or MOGAD (n = 221), who were followed at a nationally commissioned Oxford service and categorized based on the presence of at least one AID. Outcomes included recovery from the onset attack, visual recovery after the first optic neuritis (ON) attack (≥ 6 months post attack), time to first relapse and time to death. Incomplete visual recovery was defined as visual acuity worse than LogMAR 0.1. Optical coherence tomography (OCT) assessed retinal nerve fiber layer thickness and ganglion cell-inner plexiform layer volume in a subset. RESULTS: In the AQP4-NMOSD cohort, 28% (n = 49) had at least one AID, compared to 11.3% (n = 25) in the MOGAD cohort (p < 0.001), with thyroid disease constituting the majority of these cases in both groups. In MOGAD, the median age of first attack was significantly higher in the AID group (46 years; IQR: 35-56) than in the non-AID group (35 years; IQR: 28-47) (p = 0.004), a difference that was not observed in the AQP4-NMOSD cohort. In both the AQP4-NMOSD (n = 175) and the MOGAD (n = 221) cohorts, age was a significant predictor of outcome in univariate analyses (AQP4-NMOSD: OR = 0.96 per year, 95% CI: 0.94-0.98, p < 0.001; MOGAD: OR = 0.97 per year, 95% CI: 0.94-0.99, p = 0.008). No significant differences were observed in clinical or visual recovery rates between AID and non-AID patients in either cohort. There were no statistically significant differences observed between AID and non-AID cohorts for clinical or visual recovery outcomes. Similarly, AID status did not influence time to relapse (AQP4-NMOSD: HR = 1.0, 95% CI: 0.63-1.58, p = 0.99; MOGAD: HR = 0.78, 95% CI: 0.40-1.52, p = 0.47) or time to death (AQP4-NMOSD: HR = 0.5, 95% CI: 0.18-1.36, p = 0.28). OCT analysis revealed no significant differences in retinal parameters between AID and non-AID groups in both cohorts. CONCLUSIONS: Additional autoimmune diseases are unlikely to significantly affect clinical or visual outcomes in early attacks in patients with AQP4-NMOSD and MOGAD.