Tocilizumab in Refractory Neuro Myelitis Optica Spectrum Disorder and Myelin Oligodendrocyte Glycoprotein Antibody–Associated Disease - Experience from a Tertiary Care Centre

Neuromyelitis optica spectrum disorder (NMOSD) and myelin oligodendrocyte glycoprotein antibody–associated disease (MOGAD), are severe inflammatory autoimmune diseases of the central nervous system. Our objective was to investigate the effects of tocilizumab (TCZ) in patients with refractory NMOSD and MOGAD, as measured by the annualized relapse rate (ARR). A prospective study was done in the Department of Neurology at Nizam’s Institute of Medical Sciences, Hyderabad, from February 2021 to December 2024. Clinical details and imaging observations were recorded in a proforma. Patients with refractory NMOSD and MOGAD were given an injection of TCZ (8 mg/kg) infusion every month. Five patients were included in our cohort, with a male-to-female ratio of 2:3. Two had aquaporin-4 antibody, and three had MOG Ab positivity. The mean age of presentation was 16.8 ± 2.14 years (range 9 to 30 years). All patients showed significant improvement, with a post-treatment ARR of 0. The mean duration of follow-up was 3 ± 2.09 years. This study supports TCZ as a therapeutic option in severe refractory disease with recurrent presentations, incomplete recovery, and severe Expanded Disability Status Scale.