Maintenance MOGAD therapy can be safely discontinued

Findings from a retrospective, multicentre, cohort study suggest discontinuation of maintenance therapy in adults with myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a safe and sustainable strategy. It can be considered after 2 years without relapse.

Data on the risk of relapse following maintenance therapy discontinuation in MOGAD is limited. One of the few available reports is a Korean cohort study of 41 MOGAD participants, 10 of whom (24.4%) relapsed a median of 8.2 months after therapy cessation [1]. Relapse was associated with a prior relapsing course and with shorter durations of immunosuppressive therapy. Currently, there are no guidelines addressing this aspect of treatment.

Against this background, a retrospective, multicentre, cohort study was conducted [2] to assess the relapse risk after treatment discontinuation, as defined for each disease-modifying therapy (DTM), in a large cohort of adult patients with MOGAD, and to evaluate factors influencing disease reactivation. Cessation of treatment was categorised according to the underlying reasons: scheduled adverse events, pregnancies, or therapeutic failures.

Study presenter Dr Marine Boudot de la Motte (Foundation Hospital Adolphe de Rothschild, France) reported that 705 MOGAD participants were included, with 163 of them discontinuing therapy. The 83 participants whose discontinuation was scheduled (n=54) or related to adverse events (n=29) were included in the final analysis. The median age was 42.3 years; 63% of the participants were female, and 63% had a monophasic course. A majority of 60 participants (72.3%) were given oral immunosuppressants, while 23 (27.7%) received rituximab.

After discontinuation, 7 participants relapsed, with a median time to relapse of 0.5 years (IQR 0.1–1.4). Only 2 relapses occurred beyond the first year. All relapses were mild, with a median change in the Expanded Disability Status Scale (EDSS) of 0 (IQR 0–1). The estimated cumulative incidence of relapse at 1 year was 8.7% (95% CI 1.0–15.9). In the oral immunosuppressants and the rituximab group, 5 and 2 relapses occurred, respectively, corresponding to 1-year cumulative incidences of 10.2% and 5.6%. The risk of relapse was significantly higher in participants who had received treatment for <1 year (P=0.002), or who had been relapse-free for <2 years (P=0.01). At 1 year after discontinuation, 69.5% of participants remained off treatment.

1. Kang Y-R, et al. Multiple Sclerosis Journal. 2025;31(9):1102–9.
2. Boudot de la Motte M, et al. Outcomes following treatment discontinuation in adult patients with MOGAD. O049, ECTRIMS 2025 Congress, 24–26 September 2025, Barcelona, Spain.

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Posted on 25 November 202525 November 2025