From the Guidelines
The preferred treatment for Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease (MOGAD) involves a tailored approach, including high-dose corticosteroids for acute attacks, followed by maintenance therapy with steroid-sparing immunosuppressants, with rituximab being a promising option for long-term management, as suggested by recent studies 1.
Key Considerations
- MOGAD is a distinct disease entity from multiple sclerosis (MS), with different treatment responses and prognoses 1.
- High-dose intravenous methylprednisolone is the first-line treatment for acute attacks, with plasma exchange or intravenous immunoglobulin as alternative options for severe cases 1.
- Maintenance therapy with steroid-sparing immunosuppressants, such as rituximab, mycophenolate mofetil, or azathioprine, is recommended for patients with recurrent disease 1.
- Treatment decisions should be individualized based on attack severity, relapse frequency, and patient-specific factors, taking into account the potential ineffectiveness or harm of MS disease-modifying therapies in MOGAD patients 1.
Treatment Approach
- Acute attack management: high-dose intravenous methylprednisolone (1000mg daily for 3-5 days) as first-line treatment, with plasma exchange or intravenous immunoglobulin as alternatives for severe cases.
- Maintenance therapy: steroid-sparing immunosuppressants, such as rituximab (375mg/m² weekly for 4 weeks or 1000mg given twice, two weeks apart), mycophenolate mofetil (starting at 500mg twice daily, increasing to 1000-1500mg twice daily), or azathioprine (2-3mg/kg/day).
- Oral prednisone tapering over 2-6 months is recommended to prevent early relapses after acute treatment.
Important Considerations
- Accurate diagnosis of MOGAD is crucial for appropriate management, as MS disease-modifying therapies may be ineffective or potentially harmful in MOGAD patients 1.
- MOGAD patients may be particularly responsive to antibody-depleting treatments, such as plasma exchange or immunoadsorption, and to B cell-targeted long-term therapies, such as rituximab 1.
From the Research
Overview of MOGAD Treatment
The treatment of Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease (MOGAD) involves both acute and long-term management strategies.
Acute Treatment
- High-dose intravenous methylprednisolone is the most commonly used treatment for acute attacks, as reported in 2, 3, 4, 5, 6.
- Intravenous immunoglobulin (IVIG) and plasma exchange are considered second-line therapies for patients with insufficient response to corticosteroids, as mentioned in 2, 3, 4, 6.
Long-term Management
- Maintenance therapies aim to prevent relapses and include:
- Mycophenolate mofetil, as discussed in 3, 4, 5, 6.
- Azathioprine, mentioned in 3, 4, 6.
- IVIG, as reported in 2, 3, 4, 6.
- Oral corticosteroids, discussed in 2, 3, 4, 5, 6.
- Rituximab, mentioned in 3, 4, 6.
- Interleukin-6 receptor (IL6-R) antagonists, emerging as an effective option for non-responders, as noted in 6.