Related Experiment Videos
Treatment-associated factors potentially linked to relapse in pediatric MOG antibody-associated disease: An
Shimpei Matsuda1, Shino Shimada2, Takato Akiba3
1Department of Pediatrics, Juntendo University School of Medicine, Tokyo, Japan; Department of Clinical Neurosciences, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan; Department of Pediatrics, Kamisu Saiseikai Hospital, Ibaraki, Japan.
Background:
Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is an inflammatory demyelination disorder primarily affecting children. Pediatric-onset MOGAD typically responds well to corticosteroids; however, predictors of relapse and optimal strategies for sustained remission remain unclear.
Objective:
To explore treatment-associated factors that may be related to relapse in pediatric MOGAD, we focused on remission timing, second-line therapy, and prednisolone (PSL) tapering.
Methods:
We retrospectively analyzed 11 pediatric MOGAD cases diagnosed between 2015 and 2023. The clinical presentation, treatment course, and relapse patterns, including remission timing, second-line therapy, and PSL tapering, were reviewed.
Results:
Among the 11 pediatric patients (median age at onset: 9 years; median follow-up: 70 months), five (45.5%) experienced relapse. Delayed remission and absence of early transition to second-line therapy were observed in relapsing cases. A shorter duration of low-dose PSL tapering (median 16.5 vs 86 days) was also more frequently observed in relapsing cases. In one patient, serum MOG antibody titers rose prior to clinical relapse. These observations are hypothesis-generating and should be interpreted with caution given the small sample size.
Conclusion:
These hypothesis-generating observations suggest that optimizing acute-phase treatment may be important in reducing the relapse risk in pediatric MOGAD. Escalation to second-line therapy may warrant consideration when improvement is inadequate within the first days of acute treatment (no response by day 3 or insufficient improvement by day 5). Early escalation and a more gradual PSL taper were more often observed among patients who remained relapse-free. However, prospective studies with larger cohorts are required to confirm these findings.