From the Research
The optimal approach for steroid tapering in patients with Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease (MOGAD) involves administering oral prednisone at a dose of 12.5 mg daily for a minimum of 3 months at the onset of the disease, as this has been shown to delay time to first relapse and reduce relapse risk by 88%. This recommendation is based on the most recent and highest quality study available, which found that higher doses of oral prednisone delayed time to first relapse, with an effect estimate of 3.7% reduced hazard of relapse for every 1 mg/day dose increment 1.
Key considerations for steroid tapering in MOGAD patients include:
- Starting with a high enough dose to effectively reduce inflammation and prevent relapses
- Tapering slowly to minimize the risk of rebound inflammation and relapses
- Monitoring patients closely for signs of relapse or adverse effects during the tapering process
- Considering the use of steroid-sparing agents, such as azathioprine, mycophenolate mofetil, or rituximab, in patients who experience breakthrough relapses during tapering
It is essential to note that the evidence for steroid tapering in MOGAD is still evolving, and further studies are needed to confirm the optimal approach. However, based on the current available evidence, the recommended approach outlined above is the most effective way to manage MOGAD and minimize the risk of relapses and adverse effects. Regular monitoring for steroid side effects, including blood glucose checks, bone density monitoring, and prophylaxis against opportunistic infections, is also crucial 1, 2.