skip to main content

Relapsing MOGAD – Maintenance Therapy — SCE Neurology MCQ

Instant feedback + full explanation. One question, done properly.

HardMultiple Sclerosis & CNS InflammationRelapsing MOGAD – Maintenance TherapySCE Neurology

A 32-year-old woman presents with episodic recurrent unilateral optic neuritis (3 episodes in 2 years, same eye each time). AQP4 antibodies are negative. MOG antibodies are positive. MRI brain shows no periventricular or juxtacortical lesions. CSF shows no oligoclonal bands. What is the most appropriate long-term management strategy?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: C — Start maintenance immunosuppression for relapsing MOGAD — options include IVIg, mycophenolate, or azathioprine

Relapsing MOGAD (defined by ≥2 attacks) requires maintenance immunosuppression to prevent further relapses and cumulative neurological damage. First-line options include maintenance IVIg, mycophenolate mofetil, and azathioprine. Unlike AQP4+ NMOSD, rituximab has inconsistent efficacy in MOGAD. MS-specific DMTs (interferons, natalizumab) are not used in MOGAD. The choice of agent is guided by severity, relapse frequency, and patient factors. A: MS DMTs are not effective in MOGAD. C: Three episodes confirm a relapsing course — treatment should not be delayed. D: Rituximab has variable efficacy in MOGAD. E: Natalizumab is not used in MOGAD.

Reference: International MOGAD Panel (Banwell et al., Lancet Neurol 2023); ABN NMOSD/MOGAD Guidelines