MOG-IgG Associated Disease (MOG-AD) in Adults

This review offers a look into available treatment strategies for patients with MOG-IgG associated disease (MOG-AD). We will focus on evidence-based management options in the acute setting. We will also present recommendations for initiation of long-term immunotherapy for patients with a relapsing course and discuss our approach for monitoring disease progression and escalation of therapy. As commercial testing for MOG-IgG did not become widely available until 2016, most of the evidence concerning management is from retrospective observational studies. Acutely, 1 g daily of intravenous methylprednisolone (IVMP) for 3–5 days has been associated with better outcomes for optic neuritis. This is typically followed by a prolonged oral prednisone taper. Long-term immunotherapy is reserved for patients with relapsing or severely disabling disease. There are yet to be any prospective trials for selection of the most appropriate agent. Rituximab, azathioprine, mycophenolate mofetil, and IVIG have all been used. Disease-modifying therapies (DMTs) typically used for multiple sclerosis (MS) are avoided. IVMP followed by a prolonged prednisone taper is the mainstay of acute management. However, there is limited consensus on the best long-term immunotherapy and prospective studies are needed to compare the efficacy of different agents. The development of targeted therapies is expected in the future as the pathogenesis of MOG-IgG becomes better understood.