Sex and gender differences in autoimmune demyelinating CNS disorders: Multiple sclerosis (MS), neuromyelitis optica spectrum disorder (NMOSD) and myelin-oligodendrocyte-glycoprotein antibody associated disorder (MOGAD).

Diem, Lara; Hammer, Helly; Hoepner, Robert; Pistor, Max; Remlinger, Jana; Salmen, Anke (2022). Sex and gender differences in autoimmune demyelinating CNS disorders: Multiple sclerosis (MS), neuromyelitis optica spectrum disorder (NMOSD) and myelin-oligodendrocyte-glycoprotein antibody associated disorder (MOGAD). International Review of Neurobiology, 164, pp. 129-178. 10.1016/bs.irn.2022.06.011

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Multiple sclerosis (MS), Neuromyelitis optica spectrum disorder (NMOSD) and Myelin-Oligodendrocyte-Glycoprotein antibody associated disorder (MOGAD) are demyelinating disorders of the central nervous system (CNS) of autoimmune origin. Here, we summarize general considerations on sex-specific differences in the immunopathogenesis and hormonal influences as well as key clinical and epidemiological elements. Gender-specific issues are widely neglected starting with the lacking separation of sex as a biological variable and gender comprising the sociocultural components. As for other autoimmune diseases, female preponderance is common in MS and NMOSD. However, sex distribution in MOGAD seems equal. As in MS, immunotherapy in NMOSD and MOGAD is crucial to prevent further disease activity. Therefore, we assessed data on sex differences of the currently licensed disease-modifying treatments for efficacy and safety. This topic seems widely neglected with only fragmented information resulting from post-hoc analyses of clinical trials or real-world post-marketing studies afflicted with lacking power and/or inherent sources of bias. In summary, biological hypotheses of sex differences including genetic factors, the constitution of the immune system and hormonal influences are based upon human and preclinical data, especially for the paradigmatic disease of MS whereas specific data for NMOSD and MOGAD are widely lacking. Epidemiological and clinical differences between men and women are well described for MS and to some extent for NMOSD, yet, with remaining contradictory findings. MOGAD needs further detailed investigation. Sex-specific analyses of safety and efficacy of long-term immunotherapies need to be addressed in future studies designed and powered to answer the pressing questions and to optimize and individualize treatment.

Item Type:

Journal Article (Review Article)

Division/Institute:

04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology
04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > DCR Unit Sahli Building > Forschungsgruppe Neurologie

UniBE Contributor:

Diem, Lara, Hammer, Helly Noemi, Hoepner, Robert, Pistor, Maximilian, Remlinger, Jana Silke, Salmen, Anke

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0074-7742

Language:

English

Submitter:

Pubmed Import

Date Deposited:

31 Aug 2022 15:34

Last Modified:

05 Dec 2022 16:23

Publisher DOI:

10.1016/bs.irn.2022.06.011

PubMed ID:

36038203

Uncontrolled Keywords:

Disease course Efficacy Environmental Epidemiology Genetic Immune system Immunotherapy Phenotype Safety Sex hormones

BORIS DOI:

10.48350/172475

URI:

https://boris.unibe.ch/id/eprint/172475

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