E.U. paediatric MOG consortium consensus: Part 5 - Treatment of paediatric myelin oligodendrocyte glycoprotein antibody-associated disorders.

In recent years, the understanding about the different clinical phenotypes, diagnostic and prognostic factors of myelin oligodendrocyte glycoprotein-antibody-associated disorders (MOGAD) has significantly increased. However, there is still lack of evidence-based treatment protocols for acute attacks and children with a relapsing course of the disease. Currently used acute and maintenance treatment regimens are derived from other demyelinating central nervous system diseases and are mostly centre-specific. Therefore, this part of the Paediatric European Collaborative Consensus attempts to provide recommendations for acute and maintenance therapy based on clinical experience and evidence available from mainly retrospective studies. In the acute attack, intravenous methylprednisolone (IVMP) leads to a favourable outcome in the majority of patients and can be followed by tapering of oral steroids up to a maximum of three months to maintain the benefit of acute treatment by suppressing disease activity. Intravenous immunoglobulins (IVIG) and plasmapheresis constitute second-line therapies in case of insufficient response to IVMP. After a first relapse, maintenance treatment should be started in order to prevent further relapses and the possibility of permanent sequelae. Four first-line therapies consisting of rituximab (RTX), azathioprine, mycophenolate mofetil or monthly IVIG have been identified by the consensus group. In case of further relapses despite maintenance treatment, the consensus group recommends treatment escalation with RTX or IVIG, followed by combining those two, and ultimately adding maintenance oral steroids. Many open questions remain which need to be addressed in further international prospective evaluation of MOGAD treatment. This international collaboration is essential to expand the state of current knowledge.
Competing Interests: Declaration of competing interest Arlette L. Bruijstens, Eva-Maria Wendel, Frederik Bartels, Carsten Finke, Markus Breu, Lorraine Flet-Berliac, Aliénor de Chalus, Catherine Adamsbaum, Giorgi Laetitia, Yael Hacohen and Matthias Baumann have no conflict of interest to declare. Christian Lechner has served as a consultant for Roche, but has no conflict of interest with this manuscript. Marco Capobianco has received consultation and speaker honoraria from Almirall, Biogen, Merck, Novartis, Roche, Sanofi, TEVA. Cheryl Hemingway serves as consultant for MS treatment for Biogen, Novartis and AQP4 treatment for Roche. She is an investigator in trials with Biogen, Roche and Novartis, but has no conflict of interest with this manuscript. Evangeline Wassmer has served as a consultant for Novartis and Biogen, PTC therapeutics, GMP-Orphan and Alexion. She is an investigator in trials with Alexion, Biogen Idec, Sanofi and Novartis. Her MS research projects have been funded by the UK MS Society, Action Medical Research and Birmingham Children’s Hospital Research Foundation. Ming Lim has received consultation fees from CSL Behring, Novartis and Octapharma; received travel grants from Merck Serono; and was awarded educational grants to organise meetings by Novartis, Biogen Idec, Merck Serono, and Bayer. Ronny Wickström has received consultation fees from Octapharma and Roche. Thaís Armangue has received speaker/consultant honoraria from Novartis and Biogen and travel expenses to attend to scientific meetings from Roche outside of the submitted work. Kevin Rostásy has no conflict of interest to declare relevant to this manuscript. Kumaran Deiva has received speaker/consultant honoraria from Novartis and Biogen, but has no COI with this manuscript. Rinze F. Neuteboom participates in trials by Sanofi and Novartis and has received honoraria from Novartis and Zogenix.
(Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.)