Clinical, imaging, and immunotherapeutic features in MOGAD: a retrospective real-world cohort in Northern China.

Abstract

Background: Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a clinically heterogeneous demyelinating disorder. Current knowledge of its phenotypic spectrum and optimal treatment strategies, especially in Asian populations, remains limited.

Objectives: This study aimed to characterize the clinical and imaging features of MOGAD in a Northern Chinese cohort and to evaluate the therapeutic effects of the anti-CD20 monoclonal antibody ofatumumab.

Design: A retrospective study in a single center.

Methods: We conducted a retrospective analysis of 108 patients who tested positive for MOG antibodies between June 2018 and August 2025, ultimately diagnosing 56 patients with MOGAD comprising 17 pediatric and 39 adult cases. Clinical, imaging, and cerebrospinal fluid (CSF) data were systematically reviewed. Ten patients received ofatumumab treatment for relapse prevention. The study was approved by the Ethics Committee of Shandong Provincial Hospital Affiliated to Shandong First Medical University (SWYX: NO.2025-709) and written consent was obtained from all participants.

Results: Cortical encephalitis was the most frequent phenotype (41.1%, 23/56), followed by Unifocal Demyelination (39.3%, 22/56). Radiographically, 94.4% of patients exhibited 1-3 lesions, predominantly in cortical regions. CSF analysis revealed elevated cell counts and protein levels, with significant variation across phenotypes (p < 0.05). Adults with relapsing courses experienced greater disability progression (p = 0.006). Ofatumumab treatment resulted in no observed relapses, along with improvements in Expanded Disability Status Scale (EDSS) and modified Rankin Scale (mRS) scores and reduction in MRI lesion burden compared with baseline (all p < 0.05). Notably, 50% (5/10) of ofatumumab-treated patients discontinued glucocorticoids within 12 months, compared with 19.6% (9/46) in the conventional therapy group (p = 0.017).

Conclusion: This study delineates a distinct clinical-radiological profile of MOGAD in Northern China, characterized by a high frequency of cortical encephalitis. Furthermore, it provides preliminary evidence that ofatumumab may be a potential steroid-sparing therapeutic option for MOGAD.