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MOGAD – Maintenance Immunosuppression Timing — SCE Neurology MCQ

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ModerateMultiple Sclerosis & CNS InflammationMOGAD – Maintenance Immunosuppression TimingSCE Neurology

A 25-year-old woman with MOGAD has had a single episode of bilateral optic neuritis with complete recovery. MOG antibodies remain positive at 6 months. Her neurologist discusses whether to start maintenance immunosuppression. What is the general recommendation?

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Correct answer: B — Maintenance immunosuppression is generally not started until after a second attack in MOGAD

Unlike AQP4+ NMOSD (where maintenance treatment is started after the first attack due to high relapse rates), MOGAD has a monophasic course in >50% of cases. Therefore, maintenance immunosuppression is generally deferred until after a second attack, unless there are poor prognostic features. Persistent MOG antibody positivity is a risk factor for relapse but alone is insufficient to justify treatment. A: First-attack treatment is not routine. C: High-dose steroids are for acute attacks, not maintenance. D: Rituximab has inconsistent efficacy in MOGAD. E: MOGAD and AQP4+ NMOSD have different treatment approaches.

Reference: International MOGAD Panel (Banwell et al., Lancet Neurol 2023); Sechi et al. Practical Recommendations (2026)