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Treatment of MOG-IgG associated disease in paediatric patients: A systematic review

Bruna Klein da Costa1, Brenda Louise Banwell2, Douglas Kazutoshi Sato1

  • 1Neurology Department, School of Medicine, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Brazil / Brain Institute of Rio Grande do Sul, Av. Ipiranga, 6690, Porto Alegre 90610-000, Brazil.

Multiple Sclerosis and Related Disorders
|August 27, 2021
PubMed

Insights

This systematic review found no randomized controlled trials for MOG-IgG associated disease (MOGAD) in children. Commonly used treatments may not be the most effective for reducing relapses, highlighting the need for further research.

Area of Science:

  • Pediatric Neurology
  • Immunology
  • Systematic Review

Background:

  • Myelin oligodendrocyte glycoprotein-immunoglobulin G (MOG-IgG) associated disease (MOGAD) is a rare autoimmune demyelinating disorder.
  • Optimal treatment strategies for pediatric MOGAD remain unclear due to a lack of high-quality evidence.

Purpose of the Study:

  • To systematically review the existing literature on the treatment of MOG-IgG associated disease in pediatric patients.
  • To identify commonly used acute and maintenance therapies and assess their reported efficacy.

Main Methods:

  • A systematic literature search was conducted using PubMed (MEDLINE) for studies published between January 2012 and April 2020.
  • Included studies focused on MOGAD treatment in patients aged 18 years or younger.
  • Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed.

Main Results:

  • The review identified 72 non-controlled studies; no randomized controlled trials (RCTs) were found.
  • Intravenous methylprednisolone was the most common acute treatment (88%).
  • For maintenance, prolonged oral corticosteroids (53%), azathioprine (51%), and mycophenolate mofetil (45%) were frequently reported, particularly for relapsing MOGAD.

Conclusions:

  • Current treatment approaches for pediatric MOGAD, especially in relapsing cases, are primarily based on observational data and expert opinion.
  • Frequently used treatments did not consistently demonstrate significant reductions in annualized relapse rates in observational studies.
  • There is a critical need for well-designed RCTs with standardized outcomes to establish the safety and efficacy of MOGAD treatments in children.
Keywords:
MOG-IgG associated diseaseMyelin oligodendrocyte glycoproteinPaediatric CNS inflammatory disordersSystematic reviewTreatment

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