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  • Maintenance Immunotherapy in MOGAD: Early Steroid Benefit, Dose Thresholds, and Disability Risk - Part 2

    Maintenance Immunotherapy in MOGAD: Early Steroid Benefit, Dose Thresholds, and Disability Risk - Part 2
    2026/05/05
    In the second episode of this series, Dr. Justin Abbatemarco and Dr. Benjamin P. Trewin discuss what was found in non-steroidal maintenance therapies. Read more about this abstract on the AAN website. Show transcript: Dr. Justin Abbatemarco: Hello and welcome back. This is Justin Abbatemarco from the Cleveland Clinic. And we're joined by Ben Trewin on his abstract maintenance immunotherapy and MOGAD, early steroid benefit, dose thresholds and disability risk. Ben, in our first episode we really talked about corticosteroids, but your paper and abstract looked at other therapies. What did you find in those non-steroidal maintenance therapies? Dr. Benjamin Trewin: In addition to looking at oral corticosteroid therapies, we also looked at B-cell depleting therapies, namely rituximab and ocrelizumab, and intravenous immunoglobulin and steroid-sparing therapies, namely azathioprine and mycophenolate predominantly, I suppose a couple on methotrexate. Now, what we found, it's important to note that we were able to tease apart the effects of all these drugs with our Cox proportional hazard model chops up, follow up into distinct intervals with different combinations and permutations of these medications and their different doses in a more granular way than is allowed by previous techniques like incident rate ratios when we compare pre and post annualized relapse rate, and we think this is a strength of the study. With this methodological strength, we were able to see that steroid-sparing therapies, despite 334 patient years of data, do not appear to have any independent benefit with respect to time to next relapse. The estimate of effect there was 1.06. And then for time to confirm sustained disability, there was also no confidence signal, the confidence interval being 0.15 to 1.4, that it actually prevented any disability despite a wealth of data, which I think is an important thing to note. And I think previous studies, particularly looking with incident rate ratios, have been a little more optimistic with that. And I think there might be misattributing some of the benefit of concomitant steroids to the steroid-sparers, but it's more complex than that, of course. And then with respect to B-cell depleting therapies, we did have 48 of 261 patients exposed, which is reasonable, but not quite enough to get the signal we're looking for. However, we found something quite interesting, because when we compared the Liverpool data to the Australasian data, the two big study groups involved, we saw that it wasn't quite as effective in Liverpool as it was in Australasia in this subgroup analysis. And so we dug a little deeper, as one should, and found that the dosing is actually different. And in Australasia, we have a tendency to just give two grams of rituximab up front, or 600 milligrams of ocrelizumab. And then six-monthly, you give a gram of rituximab without fail, without trying to watch the B cells or trying to muck around with doses in any way. And when we looked at that, the threshold dosing, as we termed it, as compared to below threshold dosing, there actually was weak evidence at a PVA of 0.08 that threshold dosing is superior to below threshold dosing. And that needs to be reproduced, but I think that was an important signal. And finally, I would say IVIG, of course, has some very strong data in this area. And I think it's important from this study at least to remain a little agnostic on that as we only had 31 patients on IVIG, and so I absolutely wouldn't say it's not effective. I would say unfortunately, we had insufficient data to make any big claims about that. Dr. Justin Abbatemarco: I think some really great data to help pick apart here and help inform practice. I think your point about looking at the previous literature and trying to tease apart these steroid-sparing agents, that corticosteroids they're not uniformly addressed, and so it's difficult to think about at those previous data points, so I appreciate that. And then this dose response to the B-cell therapies, there's been questions in the literature, because I think we've gotten a lot of mixed results on B-cell therapies. And so this to me is one of the larger studies that really help answer this question that maybe B-cell therapies are effective and maybe we need to be a little more sensitive to dose, which is the same theme we saw on IVIG. IVIG, maybe at higher doses, could be more effective for MOGAD. What do you think about that comparison? Dr. Benjamin Trewin: I like where you're going with that because we're quite interested in these dose responses as we introduce this 12.5 milligram per day oral corticosteroid dose or 0.16 milligrams per kilograms per day in kid. And so we're quite interested. And, of course, that work by Dr. Chen and Dr. Mariner has revealed that IVIG also has quite a sensitive dose threshold there at one gram every four weeks. And we followed that precinct because that research was so strong. So it's nice ...
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    5 分
  • Epstein-Barr Virus Antibodies to Differentiate MS From Other Neuroinflammatory Diseases - Part 2

    Epstein-Barr Virus Antibodies to Differentiate MS From Other Neuroinflammatory Diseases - Part 2
    2026/05/04

    In the second part of this series, Dr. Justin Abbatemarco and Dr. Paulus Rommer discuss how to apply these study results into clinical practice.

    Show citation:

    Vietzen H, Kühner LM, Berger SM, et al. Epstein-Barr Virus Antibodies to Differentiate Multiple Sclerosis From Other Neuroinflammatory Diseases. JAMA Neurol. Published online March 9, 2026. doi:10.1001/jamaneurol.2026.0240

    Show transcript:

    Dr. Justin Abbatemarco:

    Hello and welcome back. This is Justin Abbatemarco, and we're finishing up our interview with Paulus Rommer on his article on JAMA Neurology, Epstein-Barr Virus Antibodies that differentiate multiple sclerosis from other Neuroinflammatory Diseases. Paulus, can we talk about how we would apply your results into clinical practice right now?

    Dr. Paulus Rommer:

    The persistent high apnea antibody responses are a hallmark of multiple sclerosis. And in our micro center study, we found that the singular measurement is not sufficient to differentiate multiple sclerosis from other related disorders like MOGAD or NMOSD, but it's the repeated high levels over time. We see them in about 95% of our MS patients, but really rarely in MOGAD or NMOSD. So this persistent high levels is a good factor, with a high accuracy, to really diagnose multiple sclerosis and to differentiate them from MOGOD or NMOSD.

    Dr. Justin Abbatemarco:

    I think these are really helpful and I think a little more evolution in how we interpret these on individual patient level, like we talked about in the podcast, but more to come. Paulus, thank you again for all your work on this topic for coming on and we're excited to have you back in the future.

    Dr. Paulus Rommer:

    Thank you.

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    2 分
  • Clinical Reasoning Series: A 70-Year-Old Man With Systemic Illness Related Strokes Refractory to Medical Treatment Managed With Intracranial Stent

    Clinical Reasoning Series: A 70-Year-Old Man With Systemic Illness Related Strokes Refractory to Medical Treatment Managed With Intracranial Stent
    2026/05/01

    Dr. Zohaib Siddiqi and Dr. Laurence Poirier discuss a complex stroke case associated with systemic vasculitis, highlighting diagnostic challenges and management strategies, including the role of endovascular therapy.

    Show citation:

    Poirier L, Brissette V, Shamy MCF, Maxwell JP, Drake B, Fahed R. Clinical Reasoning: A 70-Year-Old Man With Systemic Illness Related Strokes Refractory to Medical Treatment Managed With Intracranial Stent. Neurology. 2025;104(1):e210068. doi:10.1212/WNL.0000000000210068

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    2 分
  • Epstein-Barr Virus Antibodies to Differentiate MS From Other Neuroinflammatory Diseases - Part 1

    Epstein-Barr Virus Antibodies to Differentiate MS From Other Neuroinflammatory Diseases - Part 1
    2026/04/30

    In part one of this series, Dr. Justin Abbatemarco and Dr. Paulus Rommer discuss the relationship between Epstein-Barr virus and multiple sclerosis, as well as the questions that still remain unanswered.

    Show citation:

    Vietzen H, Kühner LM, Berger SM, et al. Epstein-Barr Virus Antibodies to Differentiate Multiple Sclerosis From Other Neuroinflammatory Diseases. JAMA Neurol. Published online March 9, 2026. doi:10.1001/jamaneurol.2026.0240

    Show transcript:

    Dr. Justin Abbatemarco:

    Hello and welcome. I just finished interviewing Paulus Rommer on his article published in JAMA Neurology, Epstein-Barr Virus Antibodies to Differentiate Multiple Sclerosis From Other Neuroinflammatory Diseases. Paulus, could we maybe talk about this relationship that we've understood about multiple sclerosis and Epstein-Barr virus? And maybe the points that still remain unanswered?

    Dr. Paulus Romme:

    There's a very long story behind this because in 1868, Pierre Marie, a student of Charcot was talking about that multiple sclerosis is a sequelae of an infection disorder. By this, we now know that there's a long story. There have been associations between infectious mononucleosis, EBV infection, multiple sclerosis. Also, the migration studies really fits very well in this. So there have been an association, but then, in 2022, there was the US Army study, Bjornevik and Ascherio, who really have shown that there is almost no multiple sclerosis without EBV infection. But still, we do not know why almost all of our patients have EBV infection, but only very small subset have multiple sclerosis. But this is very important to get a deeper understanding, but this is still unknown.

    Dr. Justin Abbatemarco:

    This story of EPV and multiple sclerosis continues to evolve. And your work, as we talked about on the podcast, has really helped inform that discussion as well. And we still need to understand, outside of the initiation of the disease, how it drives the pathophysiology years after that initial infection. But it's really helpful to understand this in the larger set and now maybe using it as a biomarker to help us with our other neuroinflammatory diseases, so we'll discuss that the next episode. Again, I was just speaking with Paulas Rommer on his article in JAMA Neurology, Epstein-Barr Virus Antibodies to Differentiate Multiple Sclerosis From Other Neuroinflammatory Diseases. Paulus, thank you.

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    2 分
  • Maintenance Immunotherapy in MOGAD: Early Steroid Benefit, Dose Thresholds, and Disability Risk - Part 1

    Maintenance Immunotherapy in MOGAD: Early Steroid Benefit, Dose Thresholds, and Disability Risk - Part 1
    2026/04/29

    In part one of this series, Dr. Justin Abbatemarco and Dr. Benjamin P. Trewin discuss the major findings from his work.

    Read more about this abstract on the AAN website.

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    4 分
  • April 20, 2026 Capitol Hill Report: Neuroscience Research in FY2027

    April 20, 2026 Capitol Hill Report: Neuroscience Research in FY2027
    2026/04/28

    In this episode, Dr. Jason Crowell discusses the Capitol Hill Report from April 20th, which provides updates on federal funding for neuroscience research in fiscal year 2027 (FY2027).

    Stay updated with what's happening on the hill by visiting aan.com/chr.

    Learn how you can get involved with AAN advocacy.

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    2 分
  • Navigating the Residency Application Process: Key Takeaways for Aspiring Neurologists

    Navigating the Residency Application Process: Key Takeaways for Aspiring Neurologists
    2026/04/27

    Casey Kozak discusses the process of applying to neurology residency. This episode offers insights for applicants and for neurologists who guide and mentor the next generation of neurologists.

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    5 分
  • Trends in Head CT Use in US Emergency Department Patients

    Trends in Head CT Use in US Emergency Department Patients
    2026/04/24

    Dr. Andy Southerland and Dr. Layne Dylla discuss the trends in head CT use in US emergency departments from 2007 to 2022, highlighting disparities, regional variations, and the potential role of AI in optimizing imaging decisions.

    Show citations:

    Dylla L, Krothapalli N, Tu L, et al. Trends in Head CT Use in US Emergency Department Patients From 2007 to 2022: A Nationwide Analysis. Neurology. 2025;105(12):e214347. doi:10.1212/WNL.0000000000214347
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    2 分