Treatment strategies of AQP4-IgG positive neuromyelitis optica spectrum disorder and MOG antibody-associated disorder in Switzerland: a nationwide survey
Introduction: Neuromyelitis optica spectrum disorders (NMOSD) and Myelin Oligodendrocyte Glycoprotein (MOG) antibody-associated disease (MOGAD) are neuroinflammatory conditions characterized by attacks, primarily affecting the spinal cord and the optic nerve. When left untreated, these disorders can result in severe neurological disability. Although recent advancements have improved treatment, many questions remain regarding the optimal management of these rare conditions. Methods: We conducted a national survey among neurologists in Switzerland experienced in treating NMOSD and MOGAD. The survey comprised 42 questions covering diagnostic methods, acute treatment, maintenance immunotherapy and approaches to long-term strategy. Results: Twenty-one out of 28 invited neurologists took part in the survey (response rate 75 %). There was high consensus on treating acute attacks with high-dose steroids and with plasmapheresis in severe cases. In NMOSD, 71.4 % recommended oral steroid tapering, compared to 85.7 % in MOGAD. All participants advocated maintenance treatment after the first attack in NMOSD, compared to only 10 % in MOGAD. Indeed, many participants advised starting therapy in MOGAD after the first attack only in cases of severe attacks (38 %), persistent MOGantibodies (10 %) or both (19 %). Rituximab was the most used first-line maintenance immunotherapy for both diseases. Approaches to treatment strategy for the long-term varied with a tendency to recommend de-escalation or discontinuation in stable patients with MOGAD, but not with NMOSD. Discussion: This study highlights current treatment approaches to NMOSD and MOGAD across Switzerland. Rituximab remains the most prescribed drug for both conditions. The overall variability in recommendations underscores the need for greater awareness of disease-specific management and for further research to optimize treatment strategies for patients with NMOSD and MOGAD.
Download
steinegger_2025-02.pdfResearchers
