Efficacy of tocilizumab in highly relapsing MOGAD with an inadequate response to intravenous immunoglobulin therapy: A case series

• Published in: Multiple sclerosis and related disorders Vol. 91; p. 105859
• Main Authors: Kang, You-Ri, Kim, Ki Hoon, Hyun, Jae-Won, Kim, Su-Hyun, Kim, Ho Jin
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.11.2024
• Subjects: Adult; Antibodies, Monoclonal, Humanized - administration & dosage; Antibodies, Monoclonal, Humanized - pharmacology; Child; Demyelinating Autoimmune Diseases, CNS - drug therapy; Demyelinating Autoimmune Diseases, CNS - immunology; Female; Humans; Immunoglobulins, Intravenous - administration & dosage; Immunoglobulins, Intravenous - pharmacology; Immunologic Factors - administration & dosage; Immunologic Factors - pharmacology; Interleukin-6; Intravenous immunoglobulin G; Middle Aged; Myelin oligodendrocyte glycoprotein antibody-associated disease; Myelin-Oligodendrocyte Glycoprotein - immunology; Neurology; Recurrence; Retrospective Studies; Tocilizumab; Treatment; ARR; Myelin oligodendrocyte glycoprotein antibody-associated disease; Tocilizumab; MMF; Intravenous immunoglobulin G; IVIG; MOGAD; NMOSD; IL-6; Interleukin-6; Treatment; RTX; ON; EDSS; annualized relapse rate; optic neuritis; neuromyelitis optica spectrum disorder; Expanded disability status scale; mycophenolate mofetil; rituximab
• ISSN: 2211-0348; 2211-0356; 2211-0356
• DOI: 10.1016/j.msard.2024.105859

•MOGAD may exhibit high disease activity despite immunotherapies.•Relapses during IVIG treatment prompted the transition to tocilizumab.•All patients in this study achieved relapse-free after tocilizumab therapy.•Tocilizumab appears effective in MOGAD patients with poor response to IVIG. Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is an inflammatory disease affecting the central nervous system that may require long-term immunotherapy in relapsing cases. While immunotherapies utilized in neuromyelitis optica spectrum disorder have shown varying efficacy in MOGAD, intravenous immunoglobulin G (IVIG) recently emerged as a promising treatment. Tocilizumab, a monoclonal antibody that targets the interleukin-6 (IL-6) receptor, has been reported to be effective in refractory MOGAD in several case studies, where tocilizumab was introduced primarily due to rituximab failure. This retrospective study was conducted in a single center and focused on MOGAD patients receiving tocilizumab therapy, who have shown limited response to various immunotherapies, including intravenous immunoglobulin G (IVIG) maintenance. This study included four patients, three adults, and one child. They experienced a median of 9 attacks (range 6-9) throughout their disease course despite at least two immunotherapies. All patients transitioned to tocilizumab after experiencing a median of two relapses (range 1-3) while on IVIG maintenance for a median of 21.9 months (range 21.3-49.6 months). Following the monthly tocilizumab administration at a dose of 8g/kg, all patients remained relapse-free with a median follow-up duration of 25.0 months (range 9.8-51.3 months) without reported adverse events. Targeting the IL-6 pathway appears to offer therapeutic benefits in highly relapsing MOGAD patients who poorly respond to IVIG maintenance therapy.