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

D. H. Whittam*, V. Karthikeayan, E. Gibbons, R. Kneen, S. Chandratre, O. Ciccarelli, Y. Hacohen, J. de Seze, K. Deiva, R. Q. Hintzen, B. Wildemann, S. Jarius, I. Kleiter, K. Rostasy, P. Huppke, B. Hemmer, F. Paul, O. Aktas, A. K. Pröbstel, G. ArrambideM. Tintore, M. P. Amato, M. Nosadini, M. M. Mancardi, M. Capobianco, Z. Illes, A. Siva, A. Altintas, G. Akman-Demir, L. Pandit, M. Apiwattankul, J. Y. Hor, S. Viswanathan, W. Qiu, H. J. Kim, I. Nakashima, K. Fujihara, S. Ramanathan, R. C. Dale, M. Boggild, S. Broadley, M. A. Lana-Peixoto, D. K. Sato, S. Tenembaum, P. Cabre, D. M. Wingerchuk, B. G. Weinshenker, B. Greenberg, M. Matiello, E. C. Klawiter, J. L. Bennett, A. I. Wallach, I. Kister, B. L. Banwell, A. Traboulsee, D. Pohl, J. Palace, M. I. Leite, M. Levy, R. Marignier, T. Solomon, M. Lim, S. Huda, A. Jacob

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

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 consensus-based treatment guidelines, while awaiting definitive clinical trials.

Original languageEnglish
JournalJournal of Neurology
Volume267
Issue number12
Pages (from-to)3565–3577
ISSN0340-5354
DOIs
Publication statusPublished - 4. Jul 2020

Keywords

  • MOG
  • MOGAD
  • Myelin oligodendrocyte glycoprotein
  • Survey

Fingerprint

Dive into the research topics of 'Treatment of MOG antibody associated disorders: results of an international survey'. Together they form a unique fingerprint.

Cite this