Outcomes After Acute Plasma Exchange for Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease

Smathorn Thakolwiboon^{1

2

3}, Vyanka Redenbaugh^{1

2}, Bo Chen^{4

5}, Sage Hewitt⁶, Shailee Shah^{6

7}, Itay Lotan^{8

9}, Michael Levy⁸, Mirasol Forcadela¹⁰, Saif Huda¹⁰, Julie Pique¹¹, Romain Marignier¹¹, Clemence Boutiere¹², Bertrand Audoin¹², Pascale Poullin¹³, Dimitrios Champsas¹⁴, David Choi¹⁵, Helen V Danesh-Meyer¹⁵, Elena Vasileiou¹⁶, Elias S Sotirchos¹⁶, James B Davis¹⁷, Amanda D Henderson^{16

17}, Adi Wilf-Yarkoni⁹, Hadas Stiebel-Kalish¹⁸, Elisabeth Maillart^{19

20}, Laura Bonelli²¹, Anthony C Arnold²¹, Marine Boudot De La Motte²², Romain Deschamps²², Jiraporn Jitprapaikulsan²³, Heather E Moss^{24

25}, Sylvia E Villarreal Navarro²⁵, Yang Mao-Draayer²⁶, Murli Mishra⁶, Nisa Vorasoot^{1

2

27}, Laura Cacciaguerra^{1

2}, Nanthaya Tisavipat^{1

2}, Deena A Tajfirouz^{1

2

28}, Jan-Mendelt Tillema^{1

2}, Sebastian A Lopez-Chiriboga^{2

29}, Jacqueline Palace⁴, Yael Hacohen¹³, Sean J Pittock^{1

2

30}, Eoin P Flanagan^{1

2

30}, John J Chen^{1

2

28}

Affiliations

¹ Department of Neurology, Mayo Clinic, Rochester, MN.
² Center for MS and Autoimmune Neurology, Mayo Clinic, Rochester, MN.
³ Department of Neurology, Mayo Clinic Health System, La Crosse, WI.
⁴ Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom.
⁵ Department of Neurology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
⁶ Department of Neurology, Vanderbilt University Medical Center, Nashville, TN.
⁷ Department of Neurology, Northwestern University, Chicago, IL.
⁸ Department of Neurology, Massachusetts General Hospital/Harvard Medical School, Boston.
⁹ Department of Neurology, Rabin Medical Center, and Sackler School of Medicine, Tel Aviv University, Israel.
¹⁰ Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom.
¹¹ Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (MIRCEM), Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France.
¹² Department of Neurology, University Hospital of Marseille, Aix Marseille University, CRMBM, France.
¹³ Department of Hemapheresis, University Hospital of Marseille, France.
¹⁴ Department of Neuroinflammation, UCL Institute of Neurology, University College London, United Kingdom.
¹⁵ Department of Ophthalmology, University of Auckland, New Zealand.
¹⁶ Department of Neurology, John Hopkins University, Baltimore, MD.
¹⁷ Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD.
¹⁸ Division of Neuro-Ophthalmology, Department of Ophthalmology, Rabin Medical Center and Felsenstein Research Center, Sackler School of Medicine, Tel Aviv University, Israel.
¹⁹ Department of Neurology, Hôpital de la Pitié-Salpêtrière, Paris, France.
²⁰ Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Paris, France.
²¹ Department of Ophthalmology, University of California Los Angeles.
²² Department of Neurology, Adolphe de Rothschild Foundation Hospital, Paris, France.
²³ Division of Neurology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
²⁴ Department of Neurology & Neurological Sciences, Stanford University, Palo Alto, CA.
²⁵ Department of Ophthalmology, Stanford University, Palo Alto, CA.
²⁶ Multiple Sclerosis Center of Excellence, Arthritis and Clinical Immunology Research Program, Oklahoma Medical Research Foundation, Oklahoma City.
²⁷ Division of Neurology, Department of Medicine, Faculty of Medicine, Khon Kaen University, Thailand.
²⁸ Department of Ophthalmology, Mayo Clinic, Rochester, MN.
²⁹ Department of Neurology, Mayo Clinic, Jacksonville, FL; and.
³⁰ Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN.

PMID: 40882166
DOI: 10.1212/WNL.0000000000213903

Multicenter Study

Outcomes After Acute Plasma Exchange for Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease

Smathorn Thakolwiboon et al. Neurology. 2025.

. 2025 Sep 23;105(6):e213903.

doi: 10.1212/WNL.0000000000213903. Epub 2025 Aug 29.

Authors

Affiliations

¹ Department of Neurology, Mayo Clinic, Rochester, MN.
² Center for MS and Autoimmune Neurology, Mayo Clinic, Rochester, MN.
³ Department of Neurology, Mayo Clinic Health System, La Crosse, WI.
⁴ Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom.
⁵ Department of Neurology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
⁶ Department of Neurology, Vanderbilt University Medical Center, Nashville, TN.
⁷ Department of Neurology, Northwestern University, Chicago, IL.
⁸ Department of Neurology, Massachusetts General Hospital/Harvard Medical School, Boston.
⁹ Department of Neurology, Rabin Medical Center, and Sackler School of Medicine, Tel Aviv University, Israel.
¹⁰ Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom.
¹¹ Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (MIRCEM), Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France.
¹² Department of Neurology, University Hospital of Marseille, Aix Marseille University, CRMBM, France.
¹³ Department of Hemapheresis, University Hospital of Marseille, France.
¹⁴ Department of Neuroinflammation, UCL Institute of Neurology, University College London, United Kingdom.
¹⁵ Department of Ophthalmology, University of Auckland, New Zealand.
¹⁶ Department of Neurology, John Hopkins University, Baltimore, MD.
¹⁷ Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD.
¹⁸ Division of Neuro-Ophthalmology, Department of Ophthalmology, Rabin Medical Center and Felsenstein Research Center, Sackler School of Medicine, Tel Aviv University, Israel.
¹⁹ Department of Neurology, Hôpital de la Pitié-Salpêtrière, Paris, France.
²⁰ Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Paris, France.
²¹ Department of Ophthalmology, University of California Los Angeles.
²² Department of Neurology, Adolphe de Rothschild Foundation Hospital, Paris, France.
²³ Division of Neurology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
²⁴ Department of Neurology & Neurological Sciences, Stanford University, Palo Alto, CA.
²⁵ Department of Ophthalmology, Stanford University, Palo Alto, CA.
²⁶ Multiple Sclerosis Center of Excellence, Arthritis and Clinical Immunology Research Program, Oklahoma Medical Research Foundation, Oklahoma City.
²⁷ Division of Neurology, Department of Medicine, Faculty of Medicine, Khon Kaen University, Thailand.
²⁸ Department of Ophthalmology, Mayo Clinic, Rochester, MN.
²⁹ Department of Neurology, Mayo Clinic, Jacksonville, FL; and.
³⁰ Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN.

PMID: 40882166
DOI: 10.1212/WNL.0000000000213903

Abstract

Background and objectives: Data on the plasma exchange (PLEX) in myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) are limited. Herein, we evaluate outcomes after PLEX in MOGAD.

Methods: This international multicenter retrospective cohort study included patients from 18 tertiary care centers in 6 countries. Inclusion criteria included fulfillment of the 2023 International MOGAD panel criteria, receipt of at least 3 sessions of PLEX, and follow-up of ≥3 months after PLEX. Patients with coexisting neuroinflammatory disorders were excluded. We assessed the frequency of complete recovery (CR), clinically significant improvement (CSI), visual acuity (VA), and Expanded Disability Status Scale (EDSS). Logistic regression analyses were performed to identify predictors of CR and CSI.

Results: Of 234 patients, 135 (58%) were female. The median (interquartile range [IQR]) age at attack was 34 (IQR 22-49) years, and 42 (17%) were children. In 165 of 243 (68%), the attack treated with PLEX was the first attack. Attack phenotypes included 161 optic neuritis (235 eyes), 77 myelitis, 24 acute disseminated encephalomyelitis, 15 brainstem/cerebellar, 3 cerebral-cortical encephalitis attack, and 1 cerebral polyfocal deficit-36 with >1 core phenotypes. A total of 239 (99%) attacks were also treated with corticosteroids and 32 (13%) with IV immunoglobulins. VA in optic neuritis improved from 20/400 (20/70-hand motion) to 20/20 (20/20-20/30), p < 0.001, and EDSS decreased from a median of 4.0 (3.0-6.5) to 1.0 (0.0-2.5), p < 0.001. Of 229 attacks without subsequent attacks within 3 months, 100 (44%) achieved CR and 213 (93%) CSI. The probability of CR was decreased with advanced age (adjusted odd ratio [95% CI] 0.97 [0.96-0.99] per year), higher EDSS worsening from baseline (0.66 [0.54-0.81] per 0.5 increment) and delayed PLEX (0.98 [0.96-0.99] per day). Advanced age (0.97 [0.96-0.99] per year) and delayed PLEX (0.95 [0.94-0.96] per day) decreased the probability of CSI.

Discussion: We observed favorable outcomes after PLEX in MOGAD attacks. However, advanced age and delayed initiation of PLEX were associated with a reduced probability of improvement. The absence of a control group limits our ability to differentiate PLEX effects from spontaneous recovery, prior corticosteroid response, or long-term immunotherapy. Future prospective studies are needed to assess the impact of PLEX on improvement.

Classification of evidence: This study provides Class IV evidence that PLEX is associated with favorable clinical outcomes in patients with MOGAD.

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Outcomes After Acute Plasma Exchange for Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease

Affiliations

Outcomes After Acute Plasma Exchange for Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease

Authors

Affiliations

Abstract

Publication types

MeSH terms

Substances