From the Research
The best treatment for Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease (MOGAD) typically involves a combination of acute and maintenance therapies, with high-dose intravenous methylprednisolone (1000 mg daily for 3-5 days) as the first-line treatment, followed by an oral prednisone taper starting at 1 mg/kg/day and gradually decreasing over 2-3 months, as supported by the most recent study 1.
Acute Treatment
For acute attacks, the following options are considered:
- High-dose intravenous methylprednisolone (1000 mg daily for 3-5 days) as the first-line treatment
- Oral prednisone taper starting at 1 mg/kg/day and gradually decreasing over 2-3 months
- If symptoms don't improve with steroids, plasma exchange (5-7 exchanges over 10-14 days) or intravenous immunoglobulin (IVIG, 2 g/kg divided over 2-5 days) may be used, as suggested by 2 and 3
Maintenance Therapy
For long-term maintenance therapy in patients with recurrent disease, the following options are considered:
- Rituximab (375 mg/m² weekly for 4 weeks or 1000 mg given twice, two weeks apart, repeated every 6 months)
- Mycophenolate mofetil (starting at 500 mg twice daily and increasing to 1000-1500 mg twice daily)
- Azathioprine (2-3 mg/kg/day)
- Monthly IVIG (0.4-1 g/kg), as discussed in 4 and 5
Optimal Dosing Strategy
The optimal dose of 12.5 mg of prednisone daily in adults (0.16 mg/kg/day for children) for a minimum of 3 months at the onset of MOGAD delays time to first relapse, with an 88% reduction in relapse risk compared with those never treated in this range, as found in the study 1.
Key Considerations
Treatment should be individualized based on disease severity, relapse frequency, and patient factors, as MOGAD is an autoimmune disorder where antibodies target MOG protein on the surface of oligodendrocytes, causing inflammation and demyelination in the central nervous system, which explains why immunosuppressive and immunomodulatory therapies are effective in managing this condition.