Combined Double-Filtration Plasmapheresis and Corticosteroids are Associated with Improved Outcomes in Acute Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease: An Ambispective Multicenter Cohort Study.

BACKGROUND

Double-filtration plasmapheresis (DFPP) and intravenous methylprednisolone (IVMP) are established treatments for acute myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) attacks, but comparative efficacy data remain limited. This study aimed to compare the efficacy between IVMP monotherapy and DFPP+IVMP therapy in acute MOGAD and identify factors associated with treatment response.

METHODS

Patients with acute MOGAD attacks receiving DFPP+IVMP or IVMP alone were enrolled in the ambispective, multicenter cohort study. Primary outcome was change in Expanded Disability Status Scale (EDSS) score. Secondary outcome included absolute EDSS and modified Rankin Scale (mRS) score, the change in mRS, improvement rates of EDSS and mRS, immunological parameters, and adverse events.

RESULTS

36 MOGAD patients were enrolled (DFPP+IVMP: 15; IVMP: 21). At 3-month follow-up (3M-FU), the DFPP+IVMP group showed greater EDSS reduction [2.00 (1.00, 2.00) vs 1.00 (0.75,1.75), p=0.012] and mRS reduction [2.00 (1.00, 3.00) vs 1.00 (1.00,1.50), p=0.009] compared with IVMP alone. In the IVMP group, higher baseline EDSS score correlated with greater EDSS improvement (ρ=0.468, p=0.032). In the DFPP+IVMP group, a higher baseline EDSS score and higher serum IgG were associated with greater EDSS improvement (baseline EDSS: ρ=0.738, p=0.002; serum IgG: ρ=0.685, p=0.010). Meanwhile, longer delay to IVMP and DFPP initiation were associated with reduced benefit (delay from onset to IVMP: ρ=-0.705, p=0.003; delay from onset to DFPP: ρ=-0.660, p=0.007). In high-serum IgG patients, DFPP+IVMP showed larger EDSS and mRS improvement at 3M-FU compared with IVMP [ΔEDSS: 3.50 (1.75, 5.00) vs 1.00 (1.00, 1.00), p=0.003; ΔmRS: 3.50 (2.00, 4.00) vs 1.00 (1.00, 1.00), p=0.003], while no significant difference was observed in low-IgG patients. No severe adverse events led to treatment discontinuation.

CONCLUSION

DFPP+IVMP was associated with better functional recovery at 3M-FU compared to IVMP group for acute MOGAD, particularly in patients with high baseline serum IgG, and early intervention was important.