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

Item Type:Article
Title:Treatment of MOG antibody associated disorders: results of an international survey
Creators Name:Whittam, D.H. and Karthikeayan, V. and Gibbons, E. and Kneen, R. and Chandratre, S. and Ciccarelli, O. and Hacohen, Y. and de Seze, J. and Deiva, K. and Hintzen, R.Q. and Wildemann, B. and Jarius, S. and Kleiter, I. and Rostasy, K. and Huppke, P. and Hemmer, B. and Paul, F. and Aktas, O. and Pröbstel, A.K. and Arrambide, G. and Tintore, M. and Amato, M.P. and Nosadini, M. and Mancardi, M.M. and Capobianco, M. and Illes, Z. and Siva, A. and Altintas, A. and Akman-Demir, G. and Pandit, L. and Apiwattankul, M. and Hor, J.Y. and Viswanathan, S. and Qiu, W. and Kim, H.J. and Nakashima, I. and Fujihara, K. and Ramanathan, S. and Dale, R.C. and Boggild, M. and Broadley, S. and Lana-Peixoto, M.A. and Sato, D.K. and Tenembaum, S. and Cabre, P. and Wingerchuk, D.M. and Weinshenker, B.G. and Greenberg, B. and Matiello, M. and Klawiter, E.C. and Bennett, J.L. and Wallach, A.I. and Kister, I. and Banwell, B.L. and Traboulsee, A. and Pohl, D. and Palace, J. and Leite, M.I. and Levy, M. and Marignier, R. and Solomon, T. and Lim, M. and Huda, S. and Jacob, A.
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.
Keywords:Myelin Oligodendrocyte Glycoprotein, MOG, MOGAD, Survey
Source:Journal of Neurology
ISSN:0340-5354
Publisher:Springer
Date:4 July 2020
Official Publication:https://doi.org/10.1007/s00415-020-10026-y
PubMed:View item in PubMed

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