Aasim Ali, Abdullah Shahid, Javed Iqbal, Asad Ullah Ansari, Maleeha Rauf, Sameen Sarfraz, Anza Amjad, Hafiz Muhammad Yousaf Masood, Muhammad Abdullah Ali, Usama Saleem, Muhammad Asad Shabbir, Muhammad Talha Shabbir, Armaghana Abdullah, Mukesh Kumar Sharma
IL-6R inhibition was associated with substantial relapse control in selected patients with MOGAD, supporting its potential role as a maintenance therapy. However, the evidence remains limited by observational designs, heterogeneous treatment regimens and follow-up, concomitant therapies, and the influence of one large cohort.
BACKGROUND: Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) can follow a relapsing course, yet evidence for effective maintenance therapy remains limited. Interleukin-6 receptor (IL-6R) inhibition has emerged as a potential relapse-prevention strategy.
OBJECTIVES: To evaluate the efficacy and safety of tocilizumab and satralizumab in patients with MOGAD.
DESIGN: Systematic review and random-effects proportional meta-analysis conducted in accordance with PRISMA 2020.
DATA SOURCES AND METHODS: PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar were searched from inception through 14 July 2026. Eligible studies reported outcomes in patients with MOGAD treated with an IL-6R inhibitor. The primary outcome was the proportion remaining relapse-free during treatment. Secondary outcomes included annualized relapse rate (ARR), disability, MRI activity, and infectious adverse events. Proportions were pooled using DerSimonian-Laird random-effects models, and study quality was assessed using the Newcastle-Ottawa Scale.
RESULTS: Six observational studies comprising 182 treated patients were included. The pooled relapse-free proportion was 85.0% (95% CI, 78.7%-89.6%; I 2 =0%). ARR decreased consistently across studies, while disability generally stabilized or improved and MRI inflammatory activity decreased or remained stable where reported. Three studies involving 142 patients contributed safety data, with a pooled infectious adverse-event proportion of 28.0% (95% CI, 21.1%-36.0%; I 2 =0%). Four studies were rated high quality and two moderate quality.
CONCLUSION: IL-6R inhibition was associated with substantial relapse control in selected patients with MOGAD, supporting its potential role as a maintenance therapy. However, the evidence remains limited by observational designs, heterogeneous treatment regimens and follow-up, concomitant therapies, and the influence of one large cohort.