Fig. 1.

Management of MOG-AD. This proposed therapeutic management of MOG-AD is based on current evidence. Acute treatment with steroids and, if needed, subsequent plasma exchange are advised as soon as possible after an acute event. After diagnosis and, usually, acute treatment, initiation of disease-modifying therapy is advised. The choice of the disease-modifying agent should be guided by the presence or absence of poor prognostic factors for recurrence and/or disability. On this basis, treatment may require a prolonged taper with oral steroids (advised in the absence of poor prognostic factors) or the use of oral immunosuppressants or intravenous immunoglobulins along with oral steroids (advised as first choice in the presence of poor prognostic factors). If a lack of response to immunosuppressants is demonstrated or a disabling recurrence of the disease occurs after cessation of oral steroids, it is appropriate to consider monoclonal antibodies. While it is reasonable and common practice to treat relapsing patients with long-term immunosuppression, the duration of disease-modifying treatment remains uncertain. CNS central nervous system, MOG-AD myelin oligodendrocyte glycoprotein antibody disease, MOG myelin oligodendrocyte glycoprotein, IV intravenous