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Emerging Principles for Treating Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease (MOGAD)

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Abstract

Purpose of review

Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a rare inflammatory disorder of the central nervous system that affects both adults and children. Neurologic disability is relapse-driven; therefore, early diagnosis and targeted treatment are critical for effective care. We review the new MOGAD diagnostic criteria and evidence for current acute and preventative therapies.

Recent findings

The International MOGAD Panel has released the first clinical, laboratory, and radiographic criteria for MOGAD diagnosis. These criteria set the stage for evaluating clinical investigations and designing future randomized clinical trials. Prior retrospective studies have evaluated multiple off-label agents for the acute care or prevention of MOGAD attacks, and prospective randomized clinical trials are now underway.

Summary

Acute MOGAD attacks are generally responsive to high-dose corticosteroids; however, early use of plasma exchange or intravenous immunoglobulin may be beneficial for severe attacks or cases lacking corticosteroid response. A slow corticosteroid taper may lower the risk of relapse. Preventative treatment has been typically limited to patients with a definitive relapsing disease. While there is no consensus on the choice or duration of treatment, multiple therapies have been retrospectively evaluated. Prospective placebo-controlled trials for interleukin-6 receptor inhibition and neonatal Fc receptor inhibition may open new frontiers for patient care.

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Authors and Affiliations

  1. Department of Neurology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA

    Andrew B. Wolf MD & Jeffrey L. Bennett MD, PhD

  2. Department of Neurology, John Radcliffe Hospital, Oxford, UK

    Jacqueline Palace MD, DM

  3. Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, UK

    Jacqueline Palace MD, DM

  4. Department of Ophthalmology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA

    Jeffrey L. Bennett MD, PhD

  5. Programs in Neuroscience and Immunology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA

    Jeffrey L. Bennett MD, PhD

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  1. Andrew B. Wolf MD
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Correspondence to Jeffrey L. Bennett MD, PhD.

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Conflict of Interest

Dr. Wolf reports research grants from the Rocky Mountain Multiple Sclerosis Center, payments for clinical trials from Genentech, and honoraria for the creation of educational content from MedLink Neurology. Dr. Palace reports support for scientific meetings and honorariums for advisory work from Merck Serono, Novartis, Chugai, Alexion, Roche, Medimmune, Argenx, Vitaccess, UCB, Mitsubishi, Amplo, and Janssen; grants from Alexion, Argenx, Roche, Medimmune, and Amplo Biotechnology; patent ref P37347WO and licence agreement Numares multimarker MS diagnostics; shares in AstraZeneca. Her group has been awarded an ECTRIMS fellowship and a Sumaira Foundation grant to start later this year. A Charcot fellow worked in Oxford in 2019–2021. She acknowledges partial funding to the trust by highly specialized services from NHS England. She is on the medical advisory boards of the Sumaira Foundation and MOG project charities, is a member of the Guthy Jackon Foundation Charity, is on the board of the European Charcot Foundation and the steering committee of MAGNIMS and the UK NHSE IVIG Committee, chairman of the NHSE neuroimmunology patient pathway, an ECTRIMS council member on the educational committee since June 2023, and on the ABN advisory groups for MS and neuroinflammation and neuromuscular diseases. Dr. Bennett reports payment for consultation from MedImmune/Viela Bio/Horizon Therapeutics, Alexion, Chugai, Clene Nanomedicine, Genentech, Genzyme, Mitsubishi Tanabe Pharma, Reistone Biopharma, TG Therapeutics, Antigenomycs, and Roche; personal fees from AbbVie; research grants from Novartis, Mallinckrodt, and Alexion; and has a patent for Aquaporumab issued.

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Wolf, A.B., Palace, J. & Bennett, J.L. Emerging Principles for Treating Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease (MOGAD). Curr Treat Options Neurol 25, 437–453 (2023). https://doi.org/10.1007/s11940-023-00776-1

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