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Myelin Oligodendrocyte Glycoprotein Antibodies in Adults with a First Demyelinating Event Suggestive of Multiple Sclerosis Villacieros-Álvarez, Javier Espejo, Carmen Arrambide, Georgina Castillo Juárez, Mireia Carbonell-Mirabent, Pere Rodriguez, Marta Bollo, Luca Castilló, Joaquín Comabella López, Manuel Galan, Ingrid Midaglia, Luciana Mongay-Ochoa, Neus Nos, Carlos Rio, Jordi Rodríguez Acevedo, Breogán Sastre-Garriga, Jaume Tur, Carmen Vidal-Jordana, Angela Vilaseca, Andreu Zabalza, Ana Auger, Cristina Rovira, Alex Montalban, Xavier Tintoré, Mar Cobo-Calvo, Álvaro Objective: Myelin oligodendrocyte glycoprotein antibodies (MOG-Ab) distinguish multiple sclerosis (MS) from MOG-associated disease in most cases. However, studies analyzing MOG-Ab at the time of a first demyelinating event suggestive of MS in adults are lacking. We aimed to (1) evaluate the prevalence of MOG-Ab in a first demyelinating event suggestive of MS and (2) compare clinical and paraclinical features between seropositive (MOG-Ab+) and seronegative (MOG-Ab-) patients. Methods: Six hundred thirty adult patients with available serum samples obtained within 6 months from the first event were included. MOG-Ab were analyzed using a live cell-based assay. Statistical analyses included parametric and nonparametric tests, logistic regression, and survival models. Results: MOG-Ab were positive in 17 of 630 (2.7%). Fourteen out of 17 (82.4%) MOG-Ab+ patients presented with optic neuritis (ON) compared to 227of 613 (37.0%) MOG-Ab- patients (p = 0.009). Cerebrospinal fluid-restricted oligoclonal bands (CSF-OBs) were found in 2 of 16 (12.5%) MOG-Ab+ versus 371 of 601 (61.7%) MOG-Ab- subjects (p < 0.001). Baseline brain magnetic resonance imaging (MRI) was normal in 9 of 17 (52.9%) MOG-Ab+ versus 153 of 585 (26.2%) MOG-Ab- patients (p = 0.029). Absence of CSF-OBs and ON at onset were independently associated with MOG-Ab positivity (odds ratio [OR] = 9.03, 95% confidence interval [CI] = 2.04-53.6, p = 0.009; and OR = 4.17, 95% CI = 1.15-19.8, p = 0.042, respectively). Of MOG-Ab+ patients, 22.9% (95% CI = 0.0-42.7) compared to 67.6% (95% CI = 63.3-71.3) of MOG-Ab- patients fulfilled McDonald 2017 criteria at 5 years (log-rank p = 0.003). Interpretation: MOG-Ab are infrequent in adults with a first demyelinating event suggestive of MS. However, based on our results, we suggest to determine these antibodies in those patients with ON and absence of CSF-OBs, as long as the brain MRI is not suggestive of MS. ANN NEUROL 2024;95:116-128. 2024 Article https://ddd.uab.cat/record/306112 urn:10.1002/ana.26793 urn:oai:ddd.uab.cat:306112 urn:scopus_id:85173020517 urn:articleid:15318249v95n1p116 urn:oai:egreta.uab.cat:publications/1fe7ca65-fe72-4bdc-928c-a3fddf86a441 eng Instituto de Salud Carlos III FI21/00282 Instituto de Salud Carlos III JR19/00007 Instituto de Salud Carlos III PI20/00800 Annals of neurology ; Vol. 95, Núm. 1 (january 2024), p. 116-128 open access Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. https://creativecommons.org/licenses/by-nc/4.0/ application/pdf