Title : A real-world study characterizing patients with Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease (MOGAD): A retrospective claims database study
Abstract:
Background: Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a rare, autoimmune central nervous system disease causing inflammatory demyelination and neurologic damage. Approximately 50-60% of patients experience a relapsing disease course. A single MOGAD attack could lead to severe, long-term, or permanent disability, such as trouble walking, blindness, bowel/bladder dysfunction or sexual dysfunction. There are no approved therapies for MOGAD representing a major unmet need for this disabling disease. This study characterized real-world demographics, comorbidities, and baseline costs of patients with MOGAD.
Methods: This retrospective observational study utilized the IQVIA PharMetrics® Plus Closed Health Plan claims database. Patients with a MOGAD-specific ICD-10-CM code G37.81 (≥1 inpatient or outpatient claim) with ≥3 months pre-index and ≥1 month post-index continuous enrollment between October 1, 2023, to August 31, 2025 were identified. Patients with post-index multiple sclerosis (MS) or NMOSD diagnoses or therapies were excluded.
Demographics, clinical characteristics, comorbidities, and baseline healthcare expenditures were evaluated during the pre-index period (up to 12 months). Relapse was defined as hospital admissions with a principal diagnosis code attributable to MOGAD, optic neuritis (ON), transverse myelitis (TM), acute disseminated encephalomyelitis, or cortical encephalitis or these conditions in any position when accompanied by select codes as the principal diagnosis.
Results: Among 987 MOGAD patients, mean age was 35.3 years (SD: 20.4) with 93.6% being ≤ 65; (15% aged 0–11 years, 11% aged 12–17 years), and 60% (n=591) were female. Commercial insurance was the primary payer (52%), followed by Managed Medicaid (29%), self-insured plans (13%), and State Children's Health Insurance Program (5.8%).
Over an average follow-up of 9.7 months, 3.64% (n=36) of the cohort experienced at least one relapse post-index. Clinical presentation was generally unknown/not documented during baseline (92%-overall and 81%-relapse). The rate of baseline TM was higher in relapse patients relative to the overall cohort (17% vs 4.6%), while ON rates were similar (2.8% and 2.9%), respectively.
Among prevalent (?10%) comorbidities; rates in relapse patients were higher than overall; hypertension (36% vs 25%), anxiety (39% vs 24%), depression (25% vs 17%), and hemiplegia (22% vs 5.3%), respectively. A higher rate of chronic pulmonary disease was observed in the overall cohort (14% vs 2.8%).
The 12-month mean baseline total cost for the overall cohort was $47,698 (SD: $112,771; median: $16,263), and was higher in the relapse cohort ( $74,471 [SD: $88,761]; median: $37,673). Similarly, the 3-month mean baseline cost was $16,845 (SD: $55,866) and $30,979 (SD: $32,333), respectively.
Conclusion: In this real-world cohort, MOGAD affected a relatively young population, including a substantial pediatric and adolescent subgroup. Psychiatric, neurologic, and cardiometabolic comorbidity burden was notable. Baseline healthcare costs were high given this younger MOGAD population. Patients with relapse had even greater neurologic morbidity and higher costs, underscoring the incremental burden associated with relapsing disease. These findings highlight the broad clinical and economic burden of MOGAD and support the need for improved disease recognition, monitoring, and management strategies.
