Efficacy and safety of immunosuppressive therapy in myelin oligodendrocyte glycoprotein antibody–associated disease: a systematic review and meta-analysis

Abstract

Background: A considerable number of patients with myelin oligodendrocyte glycoprotein antibody–associated disease (MOGAD) will experience a relapse, but the effect of maintenance therapies on re-attack rates is currently unknown. Objective: To investigate the efficacy and safety of immunosuppressive therapy for preventing disease relapses in patients with MOGAD, including rituximab (RTX), mycophenolate mofetil (MMF), and azathioprine (AZA). Methods: English-language studies published prior to August 31, 2020, were searched in the NCBI (PubMed), ISI Web of Science, and the Cochrane Library databases. Patient characteristics, treatment regimens, outcome measures, and adverse effects were retrieved. Results: We enrolled 11 studies in the final meta-analysis, including 346 patients with MOGAD. RTX therapy was demonstrated to result in reduced mean annualized relapse rate (ARR) by 1.35 (95% confidence interval (CI): 0.85–1.85) and reduced mean Expanded Disability Status Scale score by 0.80 (95% CI: 0.53–1.08) in patients with MOGAD. MMF therapy was associated with the mean ARR decreasing by 0.83 (95% CI: 0.31–1.35), and AZA was related to the mean ARR decreasing by 1.71 (95% CI: 0.83–2.58). The reported discontinuation rates of RTX, MMF, and AZA therapy due to adverse effects were 3/197 (1.52%), 3/39 (7.69%), and 4/37 (10.81%), respectively. Conclusion: The study provided evidence to support the efficacy of RTX, MMF, and AZA on the preventive treatment in patients with MOGAD. However, large randomized controlled trials are still needed in the future.

Efficacy and safety of rituximab in myelin oligodendrocyte glycoprotein antibody-associated disorders compared with neuromyelitis optica spectrum disorder: a systematic review and meta-analysis

“…Our meta-analysis shows that RTX treatment is effective in reducing the relapse rate and improving neurological disability in patients with MOGAD. This is in line with previous systematic reviews, where the efficacy of several immunotherapies—including RTX—was assessed in patients with MOGAD 68–70. In addition, we found that the ARR reduction was consistent across all subgroups of patients analysed.…”

MOG encephalomyelitis after vaccination against severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2): case report and comprehensive review of the literature

“…Acute treatment should follow published recommendations and guidelines. If high-dose IVMP does not lead to rapid and complete or almost complete resolution of symptoms, escalatory PLEX is often required; sometimes IVIG is used, especially in children [ 11 , 26 ]. It should be noted that MOG-EM-associated symptoms may be steroid-dependent; OS therapy with tapering is therefore commonly used after IVMP.…”

“…It should be noted that MOG-EM-associated symptoms may be steroid-dependent; OS therapy with tapering is therefore commonly used after IVMP. Whether long-term immunosuppressive/immunomodulatory therapy (often with azathioprine, rituximab, MMF or, especially in children, IVIG) is required depends on clinical presentation, attack severity, the degree of symptom resolution after acute therapy, and on whether relapses occur [ 11 , 26 , 45 ]. More needs to be learned about the long-term treatment needs of patients with postvaccinal MOG-EM.…”

Frequency of NMOSD misdiagnosis in a cohort from Latin America: Impact and evaluation of different contributors

“…15,38 Strikingly, LP use during the NMOSD diagnosis process was found in 91% and positivity for OCB in 25%, consistent with previous data. 1,2 There is solid evidence that MS DMDs such as interferons, natalizumab, fingolimod, and alemtuzumab, which are usually used to treat MS patients, are ineffective in NMOSD patients (including MOGAD patients) 39 and can even increase annualized relapse rates. 6 Likewise, MS DMDs have a significant economic burden with potential serious adverse effects.…”