Acute Attack Treatment Escalation and Subsequent Relapse Risk in Pediatric Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease

OBJECTIVES: Acute treatment for myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) includes high-dose IV methylprednisolone (IVMP), with escalation to IV immunoglobulin (IVIG) and/or plasma exchange (PLEX) based on severity or incomplete response. We evaluated whether escalation at first attack influences disease course. METHODS: We conducted a retrospective single-center study of pediatric-onset MOGAD evaluated between 2015 and 2024. Patients were classified to (1) steroid-only or (2) steroid-plus (IVMP followed by IVIG, PLEX, or both). Outcomes included early (≤1 year) and overall relapses. Time-to-event analyses used Kaplan-Meier and adjusted Cox regression. RESULTS: = 0.022). DISCUSSION: Acute immunotherapy escalation was associated with lower early and mid-term relapses, suggesting the first attack may represent a therapeutic opportunity to influence disease trajectory.