2026 American Academy of Neurology Autoimmune Abstract Website

Andreu Vilaseca-Jolonch¹, Philippe-Antoine Bilodeau², Georgios Gakis³, Andrea savransky⁴, Joao Vitor Mahler⁵, Linda Nguyen⁶, Sam Hooshmand⁷, Sammita Satyanarayan⁸, Carson Moseley⁹, Leah Haley¹⁰, Chantal Roy-Hewitson¹¹, Mariano Marrodan¹², Adriana Casallas Vanegas¹³, Analisa Manin¹⁴, Haiwen Chen³, Fabian Murillo¹⁵, Yoji Hoshina¹⁶, Aniela Grzezulkowska¹⁷, Edgar Carnero Contentti¹⁸, Lorna Galleguillos¹⁹, Margaret Upchurch²⁰, Caitlin Jackson-Tarlton²¹, Joanne Chu-Yueh Guo²², Michelle Fabian²³, Akash Virupakshaiah²², Stephanie Syc-Mazurek¹, Laura Cacciaguerra¹, Mulan Jiang¹⁵, Nathane Braga da Silva Rezende²⁴, Georgina Arrambide²⁵, Cesar Caparó-Zamalloa²⁶, Rafael Paterno²⁷, Emmanuelle Waubant²⁸, Laura Ordoñez²⁹, Jorge Correale³⁰, Andres Villa¹⁴, Dean Wingerchuk¹, Brenda Banwell³¹, Romain Marignier³², Sean Pittock³³, Benjamin Greenberg⁶, Susan Horsman¹, Jeffrey Bennett³⁴, Tracey Cho¹⁷, Stacey Clardy³⁵, Andrew Solomon³⁶, Ilya Kister³⁷, Scott Zamvil³⁸, Jeffrey Gelfand⁹, Pavle Repovic³⁹, Ahmed Obeidat⁷, Kyle Blackburn⁴⁰, Silvia Tenembaum⁴, John Chen¹, Elias Sotirchos³¹, Michael Levy⁴¹, Eoin Flanagan¹
¹Mayo Clinic, ²Massachusetts General Hospital, ³Johns Hopkins, ⁴Paediatric Neuroimmunology Clinic, Department of Neurology, National Paediatric Hospital Dr J P Garrahan, Ciudad de Buenos Aires, Argentina., ⁵Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA., ⁶UT Southwestern Medical Center, ⁷Medical College of Wisconsin, ⁸Mount Sinai Medical Center, ⁹University of California, San Francisco, ¹⁰Department of Neurology, New York University Langone Medical Centre, New York, NY, USA., ¹¹University of Vermont Medical Center, ¹²Institute for Neurological Research Raul Carrea. Fleni, ¹³Cayre Multiple Sclerosis Center, Bogotá, Colombia., ¹⁴Hospital Ramos Mejia, ¹⁵Massachusetts General Hospital and Harvard Medical School, ¹⁶University of Utah Health, ¹⁷Department of Neurology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, Iowa 52242, USA., ¹⁸Neuroimmunology Unit, Department of Neurosciences, Hospital Aleman, Buenos Aires, Argentina; CENRos, Neuroimmunology Clinic, INECO Neurociencias Oroño, Rosario, Argentina., ¹⁹Neuroimmunology Unit, Department of Neurology and Psychiatry, Clinica Alemana of Santiago, Chile, ²⁰Departments of Neurology and Ophthalmology, Programs in Neuroscience and Immunology, University of Colorado Anschutz School of Medicine, Aurora, CO, USA., ²¹Department of Medicine, Division of Neurology, Dalhousie University, Halifax, Canada., ²²UCSF, ²³Mount Sinai Hospital, ²⁴Department of Internal Medicine (Clinical Medicine), School of Medicine, Universidad de Estácio de Sá, Rio de Janeiro, Brasil., ²⁵Cemcat, Vall d´Hebron University Hospital, ²⁶Centro Básico de Investigación en Demencia y enfermedades desmielinizantes del SNC, Instituto Nacional de Ciencias Neurológicas, Lima - Perú., ²⁷Irmandade da Santa Casa de São Paulo, Serviço de Neurologia, São Paulo SP, Brazil., ²⁸USCF MS Center, ²⁹Department of Neurology, Hospital Español de Mexico., ³⁰Institute for Neurological Research, ³¹Johns Hopkins University, ³²Lyon University Hospital, ³³Mayo Clinic Dept of Neurology, ³⁴University of Colorado School of Medicine, ³⁵University of Utah, ³⁶Department of Neurological Sciences, Larner College of Medicine at the University of Vermont, Burlington, VT, USA., ³⁷NYU School of Medicine, ³⁸University of CA, San Francisco, ³⁹Multiple Sclerosis Center, ⁴⁰University of Texas Southwestern Medical Center, ⁴¹Massachusetts General Hospital/Harvard Medical School

Objective:

To evaluate the impact of IL-6RB therapy on relapse rates in MOGAD and compare relapse frequency with intravenous immunoglobulin (IVIG).

Background:

Myelin oligodendrocyte glycoprotein antibody–associated disease (MOGAD) lacks approved relapse-preventive therapies. Observational studies of relapse-prevention in MOGAD can guide clinical practice while approved treatments are awaited and comparative data can assist decision making. Interleukin-6-receptor-blocker (IL-6RB) in MOGAD are often reserved for 2nd- or 3rd-line treatments and used infrequently.

Design/Methods:

We conducted an international, multicenter, retrospective observational cohort study across sites in North and South America (1/1/2015-12/31/2025). Outcomes included annualized relapse rate (ARR) during IL-6RB therapy, time-to-next-relapse after treatment initiation, and adverse events. Relapse outcomes were compared with a historical IVIG-treated cohort receiving varying IVIG doses using inverse probability of treatment weighting (IPTW), adjusted for age, sex, prior ARR, and concomitant therapies.

Results:

We included 116 MOGAD patients (89% relapsing) on IL-6RB (tocilizumab 104[90%], satralizumab 12[10%]); overall, 60% were female and 18% <18 years. The median on-IL-6RB-treatment follow-up was 1.4 years (IQR,0.7-2.5) and 23 relapses occurred during 241.8 years of IL-6RB. The ARR decreased from 0.64 (95%CI, 0.58–0.70) for relapsing MOGAD before IL-6RB to 0.09 (95%CI,0.06–0.14) during IL-6RB treatment (incidence-rate-ratio,0.08[95%CI,0.04–0.16]). Adverse events occurred in 58 (50%), most commonly mild infections, although 10 (9%) had severe infections. In the IVIG cohort (n=59), 30 relapses occurred over 133.8 person-years (ARR, 0.22;95%CI,0.15–0.32). After IPTW, IL-6RB was associated with lower hazard ratio than IVIG <1g/kg-every-4-weeks (HR,4.5;95%CI,2.0–9.8), with no significant difference versus IVIG ≥1g/kg-every-4 weeks (HR, 2.0;95%CI,0.8–4.5).

Conclusions:

IL-6RB use in MOGAD was associated with very low relapse rates and a favorable safety profile, although severe infections occurred occasionally. Relapse rates were lower than with IVIG <1 g/kg every 4 weeks, but not significantly different to IVIG ≥1 g/kg every 4 weeks, supporting IL-6RBs as potential relapse-prevention therapy.