After a first relapse, maintenance treatment should be started in order to prevent further relapses and the possibility of permanent sequelae. Four first-line therapies consisting of rituximab (RTX), azathioprine, mycophenolate mofetil or monthly IVIG have been identified by the consensus group. According to the result of an international questionnaire investigation from 86 invited neurologists, the most favorable first-choice maintenance therapies in MOGAD were azathioprine (AZA), mycophenolate mofetil (MMF), and rituximab (RTX). 11 Up until now, there have been were no randomized controlled clinical trials in the maintenance. Approximately 40% of adults and 30% of children with Myelin-oligodendrocyte glycoprotein antibody-associated disease (MOGAD) experience a relapsing course, but the optimal relapse prevention therapy remains unclear. A meta- analysis was conducted to investigate the efficacy of azathioprine (AZA), mycophenolate mofetil (MMF), rituximab (RTX), maintenance intravenous immunoglobulin (IVIG), and. Currently, prolonged oral steroids, conventional immunosuppression such as azathioprine, mycophenolate mofetil, rituximab, and tocilizumab are commonly prescribed off label in adult patients with MOGAD to prevent further relapses. 8 - 12 While these treatments are generally well tolerated, long-term use raises concerns regarding infectious. According to the result of an international ques-tionnaire investigation from 86 invited neurolo-gists, the most favorable first-choice maintenance therapies in MOGAD were azathioprine (AZA), mycophenolate mofetil (MMF), and rituximab (RTX).11 Up until now, there have been were no randomized controlled clinical trials in the main-tenance. This study contains the largest multicenter experience with IVIg use for prevention of MOGAD relapses and underscores the promise of IVIg use as a maintenance therapy. Cobo-Calvo A, Sepúlveda M, Rollot F, et al. Evaluation of treatment response in adults with relapsing MOG-Ab-associated disease. J Neuroinflammation. 2019;16:134. Approximately 40% of adults and 30% of children with Myelin-oligodendrocyte glycoprotein antibody-associated disease (MOGAD) experience a relapsing course, but the optimal relapse prevention therapy remains unclear. A meta- analysis was conducted to investigate the efficacy of azathioprine (AZA), mycophenolate mofetil (MMF), rituximab (RTX), maintenance intravenous immunoglobulin (IVIG), and. In terms of incidence of relapse, intravenous immunoglobulins (IVIG), oral corticosteroids (OC), mycophenolate mofetil (MMF), azathioprine (AZA), and rituximab (RTX) were all significantly more effective than no treatment (ORs ranged from 0.075 to 0.34). A recent multicenter retrospective analysis of 70 patients with myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease (MOGAD) demonstrated that majority of patients sustained relapses on long-term immunotherapies, including rituximab (Rituxan, Genentech), mycophenolate mofetil (CellCept; Genentech), and intravenous immunoglobulins (IVIG). 1 The findings provide evidence on the. After a first relapse, maintenance treatment should be started in order to prevent further relapses and the possibility of permanent sequelae. Four first-line therapies consisting of rituximab (RTX), azathioprine, mycophenolate mofetil or monthly IVIG have been identified by the consensus group. Comparative Effectiveness IVIg demonstrates superior efficacy compared to classic immunosuppressants (azathioprine, mycophenolate) in preventing MOGAD relapses, based on emerging clinical experience 1 Unlike MS-directed therapies (interferon-β, natalizumab), which can paradoxically increase relapse rates in MOGAD, IVIg does not carry this risk.