Treatment of MOG antibody associated disorders: results of an international survey

Abstract

Introduction-While monophasic and relapsing forms of myelin oligodendrocyte glycoprotein antibody associated disorders (MOGAD) are increasingly diagnosed world-wide, consensus on management is yet to be developed. Objective-To survey the current global clinical practice of clinicians treating MOGAD.Method-Neurologists worldwide with expertise in treating MOGAD participated in an online survey (February-April 2019).Results-Fifty-two responses were received (response rate 60.5%) from 86 invited experts, comprising adult (78.8%, 41/52) and paediatric (21.2%, 11/52) neurologists in 22 countries. All treat acute attacks with high dose corticosteroids. If recovery is incomplete, 71.2% (37/52) proceed next to plasma exchange (PE). 45.5% (5/11) of paediatric neurologists use IV immunoglobulin (IVIg) in preference to PE. Following an acute attack, 55.8% (29/52) of respondents typically continue corticosteroids for ≤ 3 months; though less commonly when treating children. After an index event, 60% (31/51) usually start steroid-sparing maintenance therapy (MT); after ≤ 2 attacks 92.3% (48/52) would start MT. Repeat MOG antibody status is used by 52.9% (27/51) to help decide on MT initiation. Commonly used first line MTs in adults are azathioprine (30.8%, 16/52), mycophenolate mofetil (25.0%, 13/52) and rituximab (17.3%, 9/52). In children, IVIg is the preferred first line MT (54.5%; 6/11). Treatment response is monitored by MRI (53.8%; 28/52), optical coherence tomography (23.1%; 12/52) and MOG antibody titres (36.5%; 19/52). Regardless of monitoring results, 25.0% (13/52) would not stop MT. Conclusion-Current treatment of MOGAD is highly variable, indicating a need for consensusbased treatment guidelines, while awaiting definitive clinical trials.

Benign SARS-CoV-2 infection in MOG-antibodies associated disorder during tocilizumab treatment

“…Several therapies have been tested in order to prevent the potentially disabling relapses in MOGAD and among them the anti-IL-6 receptor tocilizumab has been newly introduced ( Whittam et al, 2020 ). During the recent pandemy of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), this monoclonal antibody has also represented an alternative treatment for a sub-group of patients affected with novel Coronavirus disease (COVID-19) ( Toniati et al, 2020 ).…”

Treatment of myelin oligodendrocyte glycoprotein immunoglobulin G–associated disease

“…Once commenced, there is a lack of consensus on how long patients should receive immunosuppression. Commonly considered factors include duration of relapse freedom, severity and frequency of prior attacks, and MOG‐IgG serostatus 12 . Interestingly similar questions are now also being asked in AQP4‐IgG NMOSD 88 .…”

“…It is also important to emphasize that a comparably more favorable outcome is not synonymous with a "favorable outcome" and it is widely recognized that MOGAD relapses can lead to severe and irreversible neurological disability. 7,12,14,15,22,27,28 2 | ACUTE AT TACK TRE ATMENTS…”

Practical recognition tools of immunoglobulin G serum antibodies against the myelin oligodendrocyte glycoprotein‐positive optic neuritis and its clinical implications

“…5,8 Some studies The current therapeutic approach for relapse prevention in MOGAD is largely adopted from NMOSD and focuses on steroidsparing agents, such as azathioprine, mycophenolate mofetil and rituximab. 99,[101][102][103] However, in contrast to AQP4-IgG-positive NMOSD, where rituximab is considered highly efficacious, there are several reports of lower efficacy in MOGAD. 8,104,105 Recent reports suggest intravenous immunoglobulins, which has been proved effective in reducing relapse rate and improving neurological disability in pediatric MOGAD, 106 might be an effective therapeutical option in adult MOGAD as well.…”