Interleukin-6 targeting antibodies for the treatment of Myelin Oligodendrocyte Glycoprotein Antibody-associated Disease (MOGAD): A review of current literature.

Abstract

Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is an autoimmune inflammatory demyelinating disorder that can manifest as optic neuritis, transverse myelitis, and acute disseminated encephalomyelitis. Although typically monophasic, relapsing cases are more common in adults. Current treatments include corticosteroids, intravenous immunoglobulin, immune-suppressive drugs, and plasma exchange, but there is emerging interest in the use of interleukin-6 (IL-6) inhibitors to prevent relapses such as tocilizumab and satralizumab. This review analyzed 24 studies on IL-6 inhibitors for MOGAD, including case reports, case series, and retrospective studies with at least one MOGAD patient. Tocilizumab demonstrated significant efficacy, with most studies reporting reduced annualized relapse rates (ARR), prolonged relapse-free periods, and improved neurological outcomes, including stabilization or recovery of vision, motor function, and magnetic resonance imaging (MRI) lesion resolution. Satralizumab also showed potential, though data were more limited. While IL-6 inhibitors appear beneficial for steroid-dependent or treatment-resistant MOGAD, the existing data are limited to small, observational studies. Larger controlled trials are needed to establish their long-term efficacy and safety.