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. 2025 Oct 15:407:578709.
doi: 10.1016/j.jneuroim.2025.578709. Epub 2025 Jul 30.

Prolonged corticosteroid therapy and steroid-sparing maintenance immunotherapy lower relapse risk in pediatric and adult MOGAD

Yoji Hoshina  1 , Suzanne Liu  2 , Melissa A Wright  2 , Alen Delic  1 , Ka-Ho Wong  3 , Robert Kadish  1 , Jonathan Galli  4 , John W Rose  4 , John E Greenlee  4 , M Mateo Paz Soldán  5 , Julia Klein  1 , Lisa K Peterson  6 , Tammy L Smith  7 , Stacey L Clardy  8
Affiliations

Prolonged corticosteroid therapy and steroid-sparing maintenance immunotherapy lower relapse risk in pediatric and adult MOGAD

Yoji Hoshina et al. J Neuroimmunol. .

Abstract

Background: Most existing literature on predictors of myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) relapse predates the 2023 diagnostic criteria and have yielded mixed results. While prolonged corticosteroid use has been shown to reduce relapse rates in some studies, the optimal dose and duration remain unclear.

Methods: We conducted a retrospective study of patients treated for MOGAD at the University of Utah and Primary Children's Hospital who met the 2023 diagnostic criteria and either experienced a relapse or were followed for ≥12 months after the initial attack. A multivariable Andersen-Gill model assessed clinical and treatment factors associated with relapse risk. Corticosteroid doses were converted to prednisone equivalents, with duration defined by the period on ≥12.5 mg/day (≥0.16 mg/kg/day in pediatric patients).

Results: Seventy-two patients were included (median onset age 25.5 [IQR 11.75-46.5] years; of these, 47 [65.3 %] female; 30 [41.7 %] pediatric). Twenty-five (34.7 %) experienced at least one relapse. Optic neuritis was more common among adults (81 % vs. 56.7 %, p = 0.049), whereas acute disseminated encephalomyelitis was more frequent among pediatric patients (33.3 % vs. 2.4 %, p < 0.001). Multivariable analysis showed that corticosteroids ≥12 weeks (HR 0.298, 95 % CI 0.1-0.887, p = 0.03) and maintenance immunotherapy (HR 0.061, 95 % CI 0.016-0.229, p < 0.001) were associated with lower relapse risk. Sensitivity analysis showed that both rituximab (HR 0.099, 95 % CI 0.024-0.407, p = 0.001) and maintenance IVIg (HR 0.058, 95 % CI 0.007-0.471, p = 0.008) were independently associated with reduced relapse risk.

Conclusion: Prolonged corticosteroid therapy for ≥12 weeks and maintenance immunotherapy with rituximab or intravenous immunoglobulin independently lower relapse risk in MOGAD.

Keywords: Corticosteroid taper; MOGAD; Maintenance IVIg; Maintenance immunotherapy; Myelin oligodendrocyte glycoprotein; Relapse risk; Rituximab.

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Conflict of interest statement

Declaration of competing interest Stacey L. Clardy reports the following disclosures: Section Editor, Neurology Podcast and Neurology Minute. Editorial Board, Neurology: Neuroimmunology and Neuroinflammation. Research support from NIH/NINDS (U01, The ExTINGUISH Trial), the Western Institute for Veteran Research, the Siegel Rare Neuroimmune Association, the Immune Deficiency Foundation, Viela Bio/Horizon, Alexion/AstraZeneca, the Barbara Gural Steinmetz Foundation, Sumaira Foundation for NMO. Consulting/Ad Board: Alexion, VielaBio/Horizon, Genentech/Roche, Guidepoint, ExpertConnect, Clarion Healthcare (*Fees to U.Utah Development account). Medical Advisory Board of the Sumaira Foundation for NMO (unpaid). Employed full time by: University of Utah Health and the Salt Lake City VA. - The remaining authors report no disclosures relevant to this manuscript.

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