Successful Treatment of Refractory Myelin Oligodendrocyte Glycoprotein Antibody–Associated Disease With Tocilizumab: A Case Report and Literature Review

Q4 Immunology and Microbiology

Clinical and Experimental Neuroimmunology Pub Date : 2025-12-07 DOI:10.1111/cen3.70040

Takahiko Katsuyama, Ryohei Horiguchi, Yuki Matsunaga, Akihiro Nishimachi, Keisuke Morihara, Hideyuki Takeuchi

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Abstract

Background

Approximately half of patients with myelin oligodendrocyte glycoprotein (MOG) antibody–associated disease (MOGAD) experience relapses, and optimal relapse-prevention strategies remain under discussion. The interleukin-6 (IL-6) signaling pathway plays a pivotal role in MOGAD pathogenesis, and its inhibition has been proposed as a promising therapeutic approach.

Case Presentation

We describe an 18-year-old male with refractory MOGAD characterized by multiple MRI-detected lesions showing an acute disseminated encephalomyelitis (ADEM)-like pattern, whose condition dramatically improved with tocilizumab. His symptoms included fever, headache, nausea, paresthesia, moria, somnolence, and seizure. Despite multiple courses of intravenous methylprednisolone, plasma exchange, and intravenous immunoglobulin, his condition remained uncontrolled. Weekly subcutaneous administration of tocilizumab, a monoclonal antibody against the IL-6 receptor, resulted in marked clinical and radiological improvement and sustained disease stabilization.

Conclusions

This case highlights the potential of IL-6 receptor inhibition with tocilizumab as an effective treatment strategy for refractory MOGAD.

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托珠单抗成功治疗难治性髓鞘少突胶质细胞糖蛋白抗体相关疾病：1例报告和文献综述

大约一半髓鞘少突胶质细胞糖蛋白（MOG）抗体相关疾病（MOGAD）患者经历复发，最佳的复发预防策略仍在讨论中。白细胞介素-6 （IL-6）信号通路在MOGAD的发病机制中起着关键作用，其抑制已被认为是一种有前景的治疗方法。我们描述了一名18岁的难治性MOGAD男性患者，其特征是mri检测到的多个病变显示急性播散性脑脊髓炎（ADEM）样模式，其病情在托珠单抗治疗下显着改善。他的症状包括发烧、头痛、恶心、感觉异常、痛觉、嗜睡和癫痫发作。尽管多次静脉注射甲基强的松龙、血浆置换和静脉注射免疫球蛋白，他的病情仍未得到控制。每周皮下注射tocilizumab（一种针对IL-6受体的单克隆抗体）可显著改善临床和放射学，并维持疾病稳定。结论：该病例强调了托珠单抗抑制IL-6受体作为难治性MOGAD的有效治疗策略的潜力。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical and Experimental Neuroimmunology Immunology and Microbiology-Immunology and Microbiology (miscellaneous)

CiteScore

1.60

自引率

0.00%

发文量