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

Whittam DH 1 , Karthikeayan V 2 , Gibbons E 2 , Kneen R 3 , Chandratre S 4 , Ciccarelli O 5 Show all authors , Hacohen Y 5 , de Seze J 6 , Deiva K 7 , Hintzen RQ 8 , Wildemann B 9 , Jarius S 9 , Kleiter I 10 , Rostasy K 11 , Huppke P 12 , Hemmer B 13 , Paul F 14 , Aktas O 15 , Pröbstel AK 16 , Arrambide G 17 , Tintore M 17 , Amato MP 18 , Nosadini M 19 , Mancardi MM 20 , Capobianco M 21 , Illes Z 22 , Siva A 23 , Altintas A 24 , Akman-Demir G 25 , Pandit L 26 , Apiwattankul M 27 , Hor JY 28 , Viswanathan S 29 , Qiu W 30 , Kim HJ 31 , Nakashima I 32 , Fujihara K 33 , Ramanathan S 34 , Dale RC 34 , Boggild M 35 , Broadley S 36 , Lana-Peixoto MA 37 , Sato DK 38 , Tenembaum S 39 , Cabre P 40 , Wingerchuk DM 41 , Weinshenker BG 42 , Greenberg B 43 , Matiello M 44 , Klawiter EC 44 , Bennett JL 45 , Wallach AI 46 , Kister I 46 , Banwell BL 47 , Traboulsee A 48 , Pohl D 49 , Palace J 4 , Leite MI 4 , Levy M 44 , Marignier R 50 , Solomon T 2 , Lim M 51 , Huda S 2 , Jacob A 2

Affiliations 

  • 1 Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK. daniel.whittam@nhs.net
  • 2 Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK
  • 3 Department of Paediatric Neurology, Alder Hey Children's Hospital, Liverpool, UK
  • 4 Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK
  • 5 Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, London, UK
  • 6 Department of Neurology and Clinical Investigation Center, CHU de Strasbourg, Hôpital de Hautepiere, Strasbourg, France
  • 7 Department of Paediatric Neurology, CHU Paris-Sud, Hôpital de Bicêtre, Le Kremlin Bicêtre, France
  • 8 Department of Neurology, MS Centre ErasMS, Erasmus MC, Rotterdam, The Netherlands
  • 9 Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany
  • 10 Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
  • 11 Department of Paediatric Neurology, Children's Hospital Datteln, Witten/Herdrecke University, Datteln, Germany
  • 12 Department of Paediatrics and Paediatric Neurology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
  • 13 Department of Neurology, School of Medicine, Technical University of Munich, Munich, Germany
  • 14 NeuroCure Clinical Research Center, and Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
  • 15 Department of Neurology, Heinrich-Heine-Universität Düsseldorf, 40225, Düsseldorf, Germany
  • 16 Department of Neurology and Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
  • 17 Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya, (Cemcat), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
  • 18 Department NEUROFARBA, Neurosciences Section, University of Florence, Florence, Italy
  • 19 Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
  • 20 Department of Medical and Surgical Neurosciences and Rehabilitation, IRCCS Giannina Gaslini Institute, Genoa, Italy
  • 21 Department of Neurology and Regional Multiple Sclerosis Centre, University Hospital San Luigi Gonzaga, Orbassano, Italy
  • 22 Department of Neurology, Odense University Hospital, Odense, Denmark
  • 23 Department of Neurology, Istanbul University Cerrahpaşa School of Medicine, Istanbul, Turkey
  • 24 Department of Neurology, School of Medicine, Koc University, Istanbul, Turkey
  • 25 Department of Neurology, Bilim University, Istanbul, Turkey
  • 26 Department of Neurology, Nitte University, Mangalore, Karnataka, India
  • 27 Neuroimmunology Unit, Department of Neurology, Prasat Neurological Institute, Ministry of Public Health, Bangkok, Thailand
  • 28 Department of Neurology, Penang General Hospital, Penang, Malaysia
  • 29 Department of Neurology, Kuala Lumpur Hospital, Ministry of Health of Malaysia, Kuala Lumpur, Malaysia
  • 30 Department of Neurology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
  • 31 Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Korea
  • 32 Department of Neurology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
  • 33 Department of Multiple Sclerosis Therapeutics, Fukushima Medical University School of Medicine and Southern TOHOKU Research Institute for Neuroscience, Koriyama, Japan
  • 34 Sydney Medical School, University of Sydney, Sydney, NSW, Australia
  • 35 Department of Neurology, Townsville Hospital, Townsville, QLD, Australia
  • 36 School of Medicine, Gold Coast Campus, Griffith University, Mount Gravatt, QLD, Australia
  • 37 CIEM MS Research Center, Federal University of Minas Gerais Medical School, Belo Horizonte, MG, Brazil
  • 38 Instituto do Cérebro do Rio Grande do Sul (InsCer), Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
  • 39 Department of Neurology, National Pediatric Hospital Dr. Juan P. Garrahan, Buenos Aires, Argentina
  • 40 Department of Neurology, Pierre Zobda Quitman Hospital, Fort-de-France, France
  • 41 Department of Neurology, Mayo Clinic, Scottsdale, AZ, USA
  • 42 Department of Neurology, Mayo Clinic, Rochester, MN, USA
  • 43 Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX, USA
  • 44 Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
  • 45 Department of Ophthalmology, University of Colorado at Anschutz Medical Campus, Aurora, CO, USA
  • 46 Department of Neurology, NYU School of Medicine, New York, NY, USA
  • 47 Department of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
  • 48 Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
  • 49 Division of Neurology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
  • 50 Service de Neurologie, Hôpital Neurologique Pierre Wertheimer Hospices Civils de Lyon, Lyon, France
  • 51 Children's Neuroscience, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
J Neurol, 2020 Dec;267(12):3565-3577.
PMID: 32623595 DOI: 10.1007/s00415-020-10026-y

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.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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