Another important study presented at this year’s AAN 2026 is the METEROID study. This is about the effect of Satralizumab in patients with MOGAD. MOGAD stands for Myelin Oligodendrocyte Glycoprotein Antibody Associated Disease. This is a rare inflammatory autoimmune disease of the CNS, characterized by the detection of high-titer antibodies against MOG (myelin oligodendrocyte glycoprotein). It was recently distinguished as its own entity from multiple sclerosis. MOGAD often manifests itself in the optic nerve (optic neuritis) but also in the spinal cord (myelitis), where the conus region is typically affected and can lead to problems with bladder or bowel control.
Satralizumab is a monoclonal antibody that specifically blocks the IL6 receptor. IL6 in turn is among other things responsible for the activation of B cells and therefore plays a key role in the pathogenesis of autoantibody-mediated diseases. Satralizumab is already approved for the treatment of neuromyelitis optica spectrum disease (NMOSD) mediated by antibodies against the water channel aquaporin-4 under the trade name Enspryng®. Its use in the also autoantibody-mediated MOGAD therefore follows a certain logic.
Study on MOGAD
A total of 132 patients with MOGAD were included in the METEROID study and randomized to either Satralizumab or placebo, while the patients were allowed to maintain a basic immunosuppression with azathioprine, MMF, oral steroids or a combination of these drugs. Patients aged ≥12 years with a positive serum finding for MOG-IgG were included. The study participants had to have recurrent attacks, i.e. either ≥1 MOGAD recurrence in the 12 months before screening or ≥2 attacks in the 24 months before screening. Approximately half of these patients were treated with oral corticosteroids.
While in the placebo group 24 patients (37.5%) suffered another relapse, there were 9 patients (13.2%) in the Satralizumab group. Accordingly, Satralizumab reduced the relative risk of suffering further MOGAD relapses within the study period by 68%. The frequency of adverse events was comparable in both groups. There were only a few serious adverse events in total, mainly all injection-related reactions were not serious. The frequency of infections and serious infections was also comparable in both groups.
Satralizumab Results Positive, Although…
The METEROID study was thus able to show that Satralizumab significantly reduces the risk of relapse in patients with recurrent MOGAD compared to placebo. METEOROID is therefore the first prospective, randomized, controlled study on MOGAD and currently the only study with positive results in MOGAD.
However, with MOGAD, the question generally arises how often recurrences or new attacks can be expected after the diagnosis. In adults, the literature reports a recurrence rate of up to 50%, and up to 40% in children. This number – according to the hypothesis of Annette Langer-Gould in a scientific session on MOGAD and NMOSD at this year’s AAN – is overestimated, partly because studies often only include patients with MOGAD recurrences (as in the METEROID study described above). Such an overestimation of the recurrence risk carries the risk of a more aggressive immunotherapy of MOGAD than actually necessary.
Therefore, the authors analyzed insurance data and evaluated the recurrence risk in a population-based cohort. Only patients who were diagnosed between 2019 – 2024, had high MOG antibody titers, and were diagnosed with the first attack were included. Based on this database, the recurrence risk is much lower than assumed and was 12.6% in adults and 10% in children. Risk factors for the occurrence of a recurrence could not be identified, and most patients also showed good clinical recovery. The results of this (albeit initially singular and few patients) population-based study does not support the immediate initiation of prophylactic immunotherapy and also does not justify long-term steroid therapy in patients with newly diagnosed MOGAD. Therefore, in light of the new MOGAD therapy studies, it will be important to identify patients with a high risk of recurrence and preferably subject this group to therapy.
This post was translated from German to English with the help of AI.
