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

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Item Type:	Article
Title:	Treatment of MOG antibody associated disorders: results of an international survey
Creators Name:	Whittam, D.H., Karthikeayan, V., Gibbons, E., Kneen, R., Chandratre, S., Ciccarelli, O., Hacohen, Y., de Seze, J., Deiva, K., Hintzen, R.Q., Wildemann, B., Jarius, S., Kleiter, I., Rostasy, K., Huppke, P., Hemmer, B., Paul, F., Aktas, O., Pröbstel, A.K., Arrambide, G., Tintore, M., Amato, M.P., Nosadini, M., Mancardi, M.M., Capobianco, M., Illes, Z., Siva, A., Altintas, A., Akman-Demir, G., Pandit, L., Apiwattankul, M., Hor, J.Y., Viswanathan, S., Qiu, W., Kim, H.J., Nakashima, I., Fujihara, K., Ramanathan, S., Dale, R.C., Boggild, M., Broadley, S., Lana-Peixoto, M.A., Sato, D.K., Tenembaum, S., Cabre, P., Wingerchuk, D.M., Weinshenker, B.G., Greenberg, B., Matiello, M., Klawiter, E.C., Bennett, J.L., Wallach, A.I., Kister, I., Banwell, B.L., Traboulsee, A., Pohl, D., Palace, J., Leite, M.I., Levy, M., Marignier, R., Solomon, T., Lim, M., 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
Volume:	367
Number:	12
Page Range:	3565-3577
Date:	December 2020
Additional Information:	Copyright © 2020, Springer-Verlag GmbH Germany, part of Springer Nature
Official Publication:	https://doi.org/10.1007/s00415-020-10026-y
External Fulltext:	View full text on PubMed Central
PubMed:	View item in PubMed

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