Successful treatment of refractory MOG-IgG-associated disease with ofatumumab: A first case report

Background

Myelin-oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a recently identified and recurrent inflammatory demyelinating disease of the central nervous system (CNS) in both adults and children. Although MOGAD acute attacks usually appear to be very responsive to high dose steroids and plasma exchange, the long-term side effects of steroids should be highlighted especially in children. Attack-prevention treatments also lack of class-I evidence and prospective randomized placebo-controlled trials are needed to better guide prevention treatment in refractory cases. Long-term immunosuppressive maintenance with mycophenolate mofetil, azathioprine or rituximab may not always effective in patients experienced recurrent demyelinating attacks.

Case presentation

We reported a rare case of 17-year-old MOGAD patient who experienced eleven relapses with azathioprine, mycophenolate mofetil and rituximab in five years, and finally effectively treated with ofatumumab (OFA), a novel fully humanized anti-CD20 mAb.

Conclusions

Timely and efficient treatment is crucial for better prognosis in refractory MOGAD. The fully humanized OFA may be an optimal choice if multiple therapeutic drugs fail to achieve remission. Further research on comparing OFA and RTX in MOG patient is needed.