Steroids vs Plasmapheresis: Which Is Better for Patients With MOGAD, NMOSD?

While patients with anti-myelin oligodendrocyte glycoprotein associated disease (MOGAD)-optic neuritis can improve without any management, patients with MOGAD-myelitis will worsen without intervention with high-dose steroids or plasmapheresis, according to study results presented at the Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS) Forum 2023, held in San Diego, California, from February 23 to 25.

Researchers assessed the efficacy of no treatment vs high-dose steroids vs plasmapheresis on disability outcomes in patients with neuromyelitis optica spectrum disease (NMOSD)- and MOGAD-optic neuritis and myelitis, and the change in expanded disability status scale in these patients following episodes of myelitis or optic neuritis.

Of the 65 patients included in the study, 25 had MOGAD (myelitis, n=11; optic neuritis, n=12) and 42 had NMOSD (myelitis, n=30; optic neuritis, n=12). The number needed to treat (NNT) and number needed to harm (NNH) for each group depending on treatment are:

• MOGAD-myelitis. Treatment with high-dose steroids: NNT=1.32 (P =.002) vs NNH=3.6
• MOGAD-optic neuritis. Treatment with high-dose steroids vs no treatment: NNT=1.02 (P <.001) vs NNT=2.08 (P =.09), respectively
• NMOSD-myelitis. Treatment with high-dose steroids vs plasmapheresis plus high-dose steroids: NNT=2.29 (P =.002) vs NNT=2.33 (P =.03).

When correcting for disease severity, while both treatments showed a lower NNT, the NNT was lower in the group receiving high-dose steroids (NNT=1.73; P =.002) vs the group receiving plasmapheresis plus high-dose steroids (NNT=1.98; P =.02).

The researchers concluded that while patients with MOGAD-optic neuritis improve without any management, they do show a marked improvement when using high-dose steroids. “Patients with MOGAD-myelitis are also very responsive to steroids, however, as opposed to MOGAD-optic neuritis, they worsened if not treated,” the researchers noted. Patients with NMOSD did not experience any improvement through the use of plasmapheresis in addition to high-dose steroids.

This article originally appeared on Neurology Advisor