This rare inflammatory disease can rapidly steal vision—plasma exchange may help
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This evidence is exciting, as many people do not respond well to the main steroid treatment for MOGAD, and without quick, effective treatment some of the damage can be irreversible.
—Marina Vilardo, MD, via a press release
Most physicians will encounter myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) rarely, if ever. But when this rare inflammatory disease strikes, it can rapidly cause blindness, paralysis, or other serious neurologic deficits.
MOGAD is an antibody-mediated inflammatory demyelinating disorder affecting the optic nerves, spinal cord, and brain. Its manifestations include optic neuritis, weakness or paralysis, confusion, seizures, and headache.
A new systematic review and meta-analysis suggests plasma exchange (PLEX) may help patients recover—particularly when corticosteroids fall short or an attack is severe.[]
Recovery rates were high, especially in optic neuritis
Researchers analyzed 10 studies with 1,045 patients who had 1,368 MOGAD attacks during the study period.[] Participants were followed for an average of 11 months. Optic neuritis occurred in 41% of attacks; 29% involved a combination of optic neuritis, spinal cord symptoms, and cerebral symptoms, while 12% involved only spinal cord symptoms.
Following PLEX, patients with optic neuritis achieved an “excellent” recovery—complete or nearly complete symptom resolution with visual acuity of 20/25 or better—in 81% of cases.[] Among patients with additional spinal cord or brain involvement, 94% experienced a “good” recovery, defined as functional improvement that did not necessarily reach the preattack baseline. PLEX-related adverse events occurred in 3% of patients.
The results add to earlier Neurology data showing that PLEX-treated MOGAD attacks frequently improve and that delayed initiation is associated with lower odds of both complete recovery and clinically significant improvement.[]
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The new findings do not establish that PLEX caused the recoveries: The included studies were observational, used inconsistent outcome definitions, and could not fully separate PLEX effects from steroid response, spontaneous recovery, or other therapies.[]
Still, the magnitude and consistency of improvement strengthen the case for considering PLEX promptly in steroid-refractory disease.
“This evidence is exciting, as many people do not respond well to the main steroid treatment for MOGAD, and without quick, effective treatment some of the damage can be irreversible,” author Marina Vilardo, MD, said in a press release.[]
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Physicians should recognize acute or rapidly progressive optic neuritis, myelitis, encephalopathy, or otherwise unexplained neurologic deficits as possible MOGAD presentations and expedite neuroimmunology evaluation and MOG-IgG testing.
For confirmed or strongly suspected severe attacks, clinicians should assess steroid response early and avoid allowing an incomplete response to become a reason for prolonged therapeutic delay. PLEX is not yet supported by randomized evidence, but these findings suggest it deserves early consideration when vision or motor function is at stake.