Timing of Treatment and Managing Attacks in MOGAD: Anastasia Vishnevetsky, MD

WATCH TIME: 7 minutes

"The question is, if we start to treat, how long do we treat? Do we keep patients on a treatment forever that they may not even be needing? That’s a tricky discussion to have. Because first MOGAD attacks can be really scary and traumatizing for patients.”

Over the years, the clinical community has gained a greater understanding of multiple sclerosis (MS) and other related immune-mediated demyelinating disorders such as neuromyelitis optica spectrum disorder and myelin oligodendrocyte glycoprotein antibody disease (MOGAD). MOG is found in the myelin that insulates nerves of the central nervous system, which consists of the brain, spinal cord, and optic nerves. A diagnosis of MOGAD is generally made when an individual has MOG-antibody in the blood, and when certain other demyelinating disorders, such as optic neuritis, transverse myelitis, or acute disseminated encephalomyelitis, occur.

Each year, in April, those around the globe celebrate MOGAD Awareness Month, a social initiative dedicated to raising awareness for the condition, which was formally discovered in 2007. Symptoms of MOGAD caused by optic neuritis include the loss or blurring of vision, loss of color vision, and eye pain, while symptoms caused by transverse myelitis include weakness, paralysis, loss of bowel or bladder control, spasticity, and tingling in the neck, back or abdomen. With no FDA-approved treatments specific to the disease, clinicians have often turned to other treatments for acute attacks, including intravenous high-dose steroids, intravenous immunoglobulin, and plasma exchange.

In an interview with Anastasia Vishnevetsky, MD, an immunology fellow at Brigham and Women’s Hospital provided key insight on the available treatment options for MOGAD, as well as the nuances with using off-label therapies commonly used in other demyelinating disorders. She spoke specifically about the importance of timing these therapies, and areas in which clinicians have seen more success in treating this patient population.