Treatment of myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD): acute attacks, relapse prevention, and symptomatic care
Journal: Frontiers in Neurology; October 9, 2026
Author(s): João Vitor Mahler, Marina Vilardo, Guilherme Diogo Silva, Anastasia Vishnevetsky, Philippe-Antoine Bilodeau, Michael Levy, Marcelo Matiello
MOGAD treatment: managing new episodes, preventing relapses, and handling symptoms
MOGAD is a unique condition of the central nervous system in which the immune system mistaken attacks the protective covering (myelin sheath) of the nerves in the brain, spinal cord, and optic nerves. Acute attacks can show up as inflammation of the optic nerve, spinal cord, or brain and is usually diagnosed based on the 2023 International MOGAD Panel criteria.
Patients experiencing MOGAD attacks usually respond to steroid treatment and recover well, but about half of adults have relapses. Often each relapse leaves patients with some disabling symptoms, and these accumulating symptoms result in long-term disability.
So treatment must focus on three approaches:
- Stopping current attacks and reversing any damage they might be causing
- Preventing relapses
- Managing ongoing symptoms due to previous episodes
This paper reviews available research on MOGAD treatment with the above objectives in mind.
Treating attacks:
High-dose steroids are generally the first treatment given during an attack, and patients often show quick and drastic improvement with this treatment. Early steroid treatment might reduce the risk of relapses and help make the disease course less aggressive.
During attacks, tests should be done for both MOG-antibodies and anti-AQP4 antibodies, but steroid treatment should be started without waiting for results of antibody tests.
When steroid treatment doesn’t work well enough, doctors may use plasma exchange (a procedure that removes harmful antibodies from the blood) or intravenous immunoglobulin (IVIG).
Another important factor related to steroid treatment is when and how to taper the steroid doses. Continuing steroids at lower doses for at least three months may help prevent early relapses, but doctors need to weigh the benefits of this against the risks, because steroids can affect growth and bone health, especially in children.
Preventing relapses:
Long-term immunosuppressive therapy may not be recommended immediately after the first episode, because more than half of all patients, especially children, may have only one episode.
Such long-term treatment is considered on a case-by-case basis, for patients with severe or recurrent attacks and consistently high antibody levels.
Since there have been no clinical trials comparing treatments for MOGAD, choice of treatment depends on the judgement of doctors and available research from smaller studies.
Regular IVIG seems to be one of the more effective options for preventing relapses. Rituximab, azathioprine, and mycophenolate mofetil are used but are less effective in MOGAD than in NMOSD. Multiple sclerosis drugs don’t work for MOGAD.
Two new treatments, satralizumab and rozanolixizumab, are being tested in clinical trials.
There’s no consensus on when patients can be taken off long-term treatment. On a case-by-case basis, treatment may be cautiously discontinued if the patient has been relapse free for several years, with a plan in place for treatment to be started again in case of any recurrence.
Managing ongoing symptoms
Even without relapses, patients may experience continual ongoing symptoms from any previous MOGAD attack. These include vision impairment, nerve pain, mobility issues, bladder and bowel dysfunction, sexual dysfunction, fatigue, and problems with mood and focus.
These symptoms affect quality of life and managing them through rehabilitation, patient education, and psychological support should form an important part of MOGAD treatment.
This review also adds some considerations for MOGAD treatment in children, pregnant women, and patients in economically disadvantaged regions.
Related article: MOGAD: A comprehensive review of clinicoradiological features, therapy and outcomes in 4699 patients globally
Free Access: Full text