Interleukin 6 Receptor Blockade for Relapse Prevention in Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease.
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Vilaseca Andreu, Bilodeau Philippe A, Gakis Georgios, Savransky Andrea, Mahler Ferreira Oliveira Joao, Nguyen Linda, Hooshmand Sam I, Satyanarayan Sammita, Moseley Carson E, Haley Leah, Roy-Hewitson Chantal, Marrodan Mariano, Casallas Adriana, Manin Analisa, Chen Haiwen, Hoshina Yoji, Grzezulkowska Aniela, Carnero Contentti Edgar, Galleguillos Lorna, Upchurch Margaret, Jackson-Tarlton Caitlin S, Chu-Yueh Guo Joanne, Fabian Michelle, Virupakshaiah Akash, Arrambide Georgina, Caparó-Zamalloa César, Paterno Rafael, Waubant Emmanuelle, Ordoñez Boschetti Laura, Correale Jorge, Villa Andres M, Banwell Brenda, Marignier Romain, Pittock Sean J, Greenberg Benjamin, Bennett Jeffrey L, Cho Tracey, Clardy Stacey, Solomon Andrew J, Kister Ilya, Zamvil Scott S, Gelfand Jeffrey M, Repovic Pavle, Obeidat Ahmed Z, Blackburn Kyle, Tenembaum Silvia, Chen John J, Sotirchos Elias S, Levy Michael, Flanagan Eoin P, and The Americas MOGAD Treatment Group, Murillo Fabian, Syc-Mazurzek Stephanie B, Cacciaguerra Laura, Jiang Mulan, da Silva Rezende Nathane Braga, Wingerchuk Dean M, Horsman Susan E
Аннотация
OBJECTIVE: To evaluate the impact of IL-6RB therapy on relapse rates in MOGAD and compare relapse frequency with intravenous immunoglobulin (IVIG).
DESIGN, SETTING, AND PARTICIPANTS: This international, multicenter, retrospective cohort study (January 1, 2015, through December 31, 2025) included a historical IVIG-treated cohort of varying doses. The study took place across sites in North and South America (US, Canada, Mexico, Argentina, Brazil, Chile, Colombia, and Peru). Patients with MOGAD (n = 116, no excluded patients) who received at least 1 dose of an IL-6RB were included. These data were analyzed in January 2026.
EXPOSURES: Tocilizumab or satralizumab.
MAIN OUTCOMES AND MEASURES: Annualized relapse rate (ARR) during IL-6RB therapy, time to next relapse after treatment initiation, and adverse events. Outcomes were compared with the IVIG cohort using inverse probability of treatment weighting (IPTW) adjusted for age, sex, prior ARR, and concomitant therapies.
RESULTS: A total of 116 patients with MOGAD (89% relapsing) receiving IL-6RB (tocilizumab, 104 [90%] and satralizumab, 12 [10%]) were included; overall, 60.3% were female, 39.7% were male, and 18% were younger than 18 years. The median (IQR) IL-6RB treatment follow-up was 1.4 (0.7-2.5) years and 23 relapses occurred during 241.8 person-years of IL-6RB therapy. The ARR decreased from 0.64 (95% CI, 0.58-0.70) for relapsing MOGAD before IL-6RB to 0.09 (95% CI, 0.06-0.14) during IL-6RB treatment (incidence rate ratio, 0.08; 95% CI, 0.04-0.16). Adverse events occurred in 58 patients (50%), most commonly mild infections, although 10 (9%) had severe infections. In the IVIG cohort (n = 59), 30 relapses occurred over 133.8 person-years (ARR, 0.22; 95% CI, 0.15-0.32). After IPTW, IL-6RB was associated with a lower hazard ratio (HR) than the group who underwent IVIG therapy less than 1 g/kg every 4 weeks (HR, 4.5; 95% CI, 2.0-9.8), with no significant difference vs the group who underwent IVIG 1 g/kg or more every 4 weeks (HR, 2.0; 95% CI, 0.8-4.5).
CONCLUSIONS AND RELEVANCE: In this multicenter observational cohort, IL-6RB use in MOGAD was associated with low relapse rates and a favorable safety profile, though severe infections occurred occasionally. Relapse rates were lower than the group who underwent IVIG less than 1 g/kg every 4 weeks but not significantly different from the group who underwent IVIG 1 g/kg or more every 4 weeks. This supports IL-6RB as a potential relapse-prevention therapy in MOGAD; the wide availability and relative affordability of tocilizumab may enable broad global use.