Abstract Details

Title Interleukin-6 Inhibition with Tocilizumab for Relapsing MOG-IgG Associated Disorder

Topic Autoimmune Neurology

Presentation(s) Autoimmune Neurology Posters (7:00 AM-5:00 PM)

Poster/Presentation
Number 050

Objective To provide evidence for the use of interleukin-6 (IL-6) inhibitors for steroid-sparing immune therapy in relapsing myelin oligodendrocyte glycoprotein-immunoglobulin G (MOG-IgG) associated disorder (MOGAD).

Background MOGAD is a demyelinating disease of the central nervous system (CNS) with a heterogeneous clinical presentation and disease course which differentiates it from aquaporin-4 (AQP4) neuromyelitis optica (NMO) and multiple sclerosis (MS). Multiple studies and clinical trials show that interleukin-6 (IL-6) plays an important role in AQP4 NMO pathophysiology and early data in MOGAD suggest similar mechanisms of CNS damage. Some patients with MOGAD exhibit a highly-relapsing and steroid-dependent disease course and the optimal treatment of these patients is unknown.

Design/Methods Case Series

Results

An 18-year old female with a 4-year history of MOGAD characterized by 6+ attacks of optic neuritis and transverse myelitis while on mycophenolate, azathioprine, and rituximab was treated with tocilizumab. Three years later, she has had no clinical relapses, no significant side effects, stopped all oral steroids, and has had near complete radiographic resolution of T2 signal changes on MRI.

A 35-year old female with a 5-year history of MOGAD characterized by 4 attacks of optic neuritis despite maintenance treatment with CellCept continued to have eye pain on maintenance IVIG requiring daily prednisone use. After starting tocilizumab, she was able to stop steroids with resolution of her paroxysmal eye pain. She had no significant side effects and no clinical or symptomatic relapses with 8 months of therapy on tocilizumab.

Conclusions Tocilizumab may be a promising therapeutic option for patients with relapsing MOGAD that has not responded to other immunotherapies. Our results further support a key role for IL-6-related mechanisms in MOGAD disease activity. Further research is needed to establish the safety and efficacy of IL-6 inhibition in MOGAD and to better understand the role of IL-6 and complement deposition in the pathogenesis of MOGAD.

Authors/Disclosures
Paul M. Elsbernd, MD (Brooke Army Medical Center) PRESENTER	Dr. Elsbernd has nothing to disclose.
William C. Hoffman	No disclosure on file
Dean M. Wingerchuk, MD, FAAN (Mayo Clinic)	Dr. Wingerchuk has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Horizon Therapeutics. Dr. Wingerchuk has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. Dr. Wingerchuk has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. Dr. Wingerchuk has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Dr. Wingerchuk has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Bristol Meyer Squibb. Dr. Wingerchuk has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for UCB Pharma. Dr. Wingerchuk has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for AstraZeneca. Dr. Wingerchuk has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. Dr. Wingerchuk has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Abcuro. Dr. Wingerchuk has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Wolters Kluwers.
Jonathan L. Carter, MD (Mayo Clinic)	Dr. Carter has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Lundbeck Pharmaceuticals A/S. The institution of Dr. Carter has received research support from MedDay Pharmaceuticals . The institution of Dr. Carter has received research support from Roche Pharmaceuticals.

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