Table 5.

Main treatment protocols in AQP4+NMOSD and MOGAD.

	Protocol	AQP4+NMOSD	MOGAD
Acute treatment of attacks
Importance	−	Residual disability	Residual disability
Steroids	Intravenous methylprednisolone 1,000 mg/day for 5 days1	+++	+++
Plasma exchange2	Every other day for 5–7 cycles	+++	++
Steroid tapering	Oral steroids 20–40 mg followed by a taper	Weeks3	Weeks-months
Chronic attack-preventive treatment 4
Importance	−	Affects long-term prognosis	Unknown
Start at first clinical attack	−	+++	+
Complement inhibitors
Eculizumab	900 mg intravenous every week for the first 4 weeks, then 1,200 mg every two weeks	+++	Not tried in trials
Ravulizumab	Body-weight-based intravenous loading dose (2,400–3,000mg) plus a body-weight-based maintenance dose (3,000–3,600mg) on day 15, then once every 8 weeks	+++	Not tried in trials
B cells depletants
Rituximab	375 mg/m2 intravenous every week for the first 4 weeks, or 1,000 mg x 2 doses 2 weeks apart and then 1,000 mg 2 weeks apart every 6 months	+++	Trial ongoing
Inebilizumab	300 mg intravenous every 15 days x 2 doses, and then every 6 months	+++	Limited data
IL-6 receptors inhibitors
Satralizumab	120 mg subcutaneously every 4 weeks	+++	Trial ongoing

Note that: “−“ indicates rare (<5%), “+” infrequent (5–30%), “++” common (30–69%), “+++” very common/very high efficacy (>70%).

¹Alternatively, oral steroids bioequivalent (i.e., prednisone 1,250 mg) may be considered given its similar efficacy in patients with optic neuritis.¹⁶³

²Intravenous immunoglobulins may be sometimes administered instead of PLEX.

³Duration may vary depending on steroid-sparing treatment making effect.

⁴We focused here on level 1 evidence of efficacy, although biosimilars of rituximab, tocilizumab, mycophenolate, and azathioprine may be used and a trial on rozanolixizumab is ongoing in MOGAD.