Therapeutic plasma exchange for MOG antibody-associated disease attacks: a systematic review and meta-analysis

Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) attacks are usually treated with corticosteroids, but therapeutic plasma exchange (TPE) may provide additional benefits.

To assess the response to TPE in MOGAD attacks.

We performed a systematic review and meta-analysis of observational studies reporting outcomes of MOGAD attacks treated with TPE, searching PubMed, Embase, and Scopus from inception to November 24, 2024. The primary outcome was recovery at last follow-up, classified as complete, partial, or none. Secondary analysis explored predictors of response through meta-regression on aggregated data.

Forty-nine studies comprising 475 attacks were included. Most patients were female (56 %), presenting mainly with optic neuritis (60 %) or myelitis (37.7 %). TPE was combined with intravenous methylprednisolone in 93 % and with intravenous immunoglobulin in 11.8 %. The pooled complete recovery rate was 30 % (95 % CI 22-40, I² = 74 %), and the overall response rate (complete or partial) was 90 % (95 % CI 82-94, I² = 59.9 %). Meta-regression indicated a slightly better response in brainstem syndrome (p=0.023) and a poorer response in cerebral syndrome (p=0.044), with no significant correlation between complete recovery and age, sex, other clinical syndromes, or use as first-line therapy.

TPE is associated with high overall response rates in MOGAD attacks. Randomized trials are needed to confirm efficacy and define prognostic factors.