Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Republic of Korea.
Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Republic of Korea; Department of Neurology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea.
Mult Scler Relat Disord. 2024 Nov;91:105859. doi: 10.1016/j.msard.2024.105859. Epub 2024 Aug 30.
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.
髓鞘少突胶质细胞糖蛋白抗体相关疾病（MOGAD）是一种影响中枢神经系统的炎症性疾病，在复发病例中可能需要长期免疫治疗。虽然视神经脊髓炎谱系疾病中使用的免疫疗法在 MOGAD 中的疗效各不相同，但静脉注射免疫球蛋白 G（IVIG）最近成为一种有前途的治疗方法。托珠单抗是一种针对白细胞介素-6（IL-6）受体的单克隆抗体，在几项病例研究中被报道对难治性 MOGAD 有效，在这些病例中，托珠单抗主要是由于利妥昔单抗治疗失败而引入。
本回顾性研究在一家单中心进行，重点关注接受托珠单抗治疗的 MOGAD 患者，这些患者对包括 IVIG 维持在内的各种免疫疗法反应有限。
这项研究包括 4 名患者，3 名成人和 1 名儿童。尽管他们接受了至少两种免疫疗法，但在疾病过程中他们经历了中位数为 9 次发作（范围 6-9）。所有患者在接受 IVIG 维持治疗中位数为 21.9 个月（范围 21.3-49.6 个月）时经历了中位数为 2 次复发（范围 1-3）后，转为托珠单抗治疗。每月给予 8g/kg 的托珠单抗剂量后，所有患者均未复发，中位随访时间为 25.0 个月（范围 9.8-51.3 个月），无不良事件报告。
靶向 IL-6 途径似乎为对 IVIG 维持治疗反应不佳的高度复发性 MOGAD 患者提供了治疗益处。
