Safety and efficacy of mycophenolate mofetil in myelin oligodendrocyte glycoprotein‐immunoglobulin G‐associated disorder among adults: A meta‐analysis

Abstract

AbstractObjectiveMyelin oligodendrocyte glycoprotein immunoglobulin G‐associated disorder (MOGAD) is an autoimmune demyelinating disorder of the central nervous system having distinct clinical phenotypes and epidemiological distribution than multiple sclerosis and neuromyelitis optica spectrum disorder. Mycophenolate mofetil has shown good safety and efficacy in multiple sclerosis and neuromyelitis optica spectrum disorder patients, but the published case series and observational studies of MOGAD showed contrasting results. Thus, we felt the need to carry out a meta‐analysis.MethodsWe searched PubMed, Embase, Cochrane Library, Google Scholar and additional sources for suitable studies. Meta‐analysis through representative forest plot was carried out for the proportion of relapse‐free patients, change in annualized relapse ratio and Expanded Disability Status Scale before and after treatment, and reduction of relapse risk.ResultsA total of nine studies were included in our meta‐analysis. Mycophenolate mofetil treatment showed approximately half the proportion (49%; 95% CI 0.26–0.73, P < .001) of relapse‐free patients at follow up. It also significantly reduced the mean annualized relapse (mean difference 0.76, 95% CI 0.49–1.03, P < .001) and relapse risk (hazard ratio 1.25, 95% CI −2.48 to −0.01, P < 0.05), but did not show a significant difference in change in Expanded Disability Status Scale score (mean difference 0.34, 95% CI −0.79 to 1.47, P = 0.56). On subgroup analysis, administration of a high dose (>2000 mg/day) showed a greater proportion of relapse‐free patients. Infections, leukopenia, fatigue, alopecia and diarrhea were common side‐effects. A total of 10.32% of patients discontinued treatment, mainly due to treatment failure.ConclusionsThe present meta‐analysis shows mycophenolate mofetil therapy as cost‐effective, well tolerated and effective for the treatment of relapses in MOGAD among adult patients.