Authors
Silvia Bartolomeo, Riccardo Nistri, Nee Na Kim, Akash Virupakshaiah, Cheryl Hemingway, Olga Ciccarelli, Yael Hacohen
Published in
Neurology. Volume 107. Issue 5. Pages e218405. Sep 08, 2026. Epub Aug 07, 2026.
Abstract
Acute treatment for myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) includes high-dose IV methylprednisolone (IVMP), with escalation to IV immunoglobulin (IVIG) and/or plasma exchange (PLEX) based on severity or incomplete response. We evaluated whether escalation at first attack influences disease course.
We conducted a retrospective single-center study of pediatric-onset MOGAD evaluated between 2015 and 2024. Patients were classified to (1) steroid-only or (2) steroid-plus (IVMP followed by IVIG, PLEX, or both). Outcomes included early (≤1 year) and overall relapses. Time-to-event analyses used Kaplan-Meier and adjusted Cox regression.
Ninety-six of 114 patients were included (58% female; median age 6.3 years [interquartile range (IQR) 4.1-11.3]; median follow-up 3.2 years [IQR 1.4-6.1]). Sixty-eight (71%) received steroid-only therapy and 28 (29%) escalation therapy. Relapses were more frequent with steroid-only treatment at 1 year (28% vs 4%; relative risk [RR] 7.80; 95% CI 1.10-55.3) and at final follow-up (43% vs 11%; RR 3.98; 95% CI 1.33-11.93). Escalation therapy was associated with reduced relapse risk (adjusted hazard ratio [HR] 0.25; 95% CI 0.07-0.85; p = 0.026; log-rank p = 0.006), consistent across propensity score-adjusted analyses (HR 0.24; 95% CI 0.07-0.81; p = 0.022).
Acute immunotherapy escalation was associated with lower early and mid-term relapses, suggesting the first attack may represent a therapeutic opportunity to influence disease trajectory.
PMID:
42566724
Bibliographic data and abstract were imported from PubMed on 08 Aug 2026.
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