Study Identifies Significant Variations in Pediatric MOGAD Treatment

The results of a study presented at the Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS) Forum 2025 found significant variations in how neurologists treat pediatric individuals with myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD).

Researchers from the Hospital for Sick Children in Toronto, Ontario, Canada conducted a survey from April through October 2024 to document neurologists’ approaches to the diagnosis and treatment of pediatric MOGAD. In all, 364 neurologists (52% general neurologists; 32% neuroimmunologists) completed surveys, which consisted of 12 questions about practice patterns along with demographic details.

The following results were reported:

• After a first event of optic neuritis, 83.24% of respondents administered a 3- to 5-day course of intravenous (IV) pulse steroids.
• There was variability in terms of steroid tapering:
  • 33.44% opted for a 2- to 4-week taper
  • 25.94% opted for a 7- to 12-week taper
  • 21.25% chose no taper
• Decisions regarding long-term maintenance therapy after the initial clinical event differed among specialists:
  • 44.51% of respondents initiated long-term therapy
  • 81.08% of neuroimmunology specialists chose not to initiate long-term therapy
  • Following a second clinical event, 98.27% of respondents recommended starting maintenance therapy.
• The most frequently prescribed maintenance therapies were:
  • Rituximab (37.06%)
  • Monthly IV immunoglobulin (IVIG) (25.59%)
  • Neuroimmunology specialists preferred monthly IVIG (50%) over rituximab (27.27%).

These findings highlight the current lack of consensus in MOGAD treatment, reflecting gaps in knowledge about optimal therapeutic approaches. Researchers concluded that the variability in treatment strategies underscores the need for further research to establish evidence-based guidelines for managing MOGAD, particularly in pediatric populations.