Latin American RAND/UCLA modified Delphi consensus recommendations for management and treatment of adult MOGAD patients in clinical practice

Abstract

Introduction: Over the last decade, myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) has seen significant advancements, with new diagnostic criteria and emerging biomarkers, increased recognition of more diverse clinical phenotypes, and new insights into disease prognosis and therapeutic strategies. Consequently, the management of MOGAD patients in Latin America (LATAM) has become more complex in clinical settings. This consensus was established to assess the best practices and treatment approaches for MOGAD in LATAM, with the goal of improving long-term outcomes for these populations. It encompasses both practical guidance and theoretical definitions to ensure a comprehensive and regionally relevant framework for diagnosis and management.

Methods: A panel of expert neurologists specializing in demyelinating diseases in LATAM met virtually from 2023 to 2024 to establish consensus recommendations for the management of MOGAD. A list of 59 statements and recommendations developed by the steering group was submitted to the rating group in the form of a questionnaire. Statements were organized into 5 categories as follows: 1-Diagnosis and serological tests; 2-Imaging and other complementary tests; 3- Prognostic factors; 4- Acute and 5- Long-term treatment. The RAND/UCLA modified Delphi panel process was utilized to achieve a formal consensus.

Results: All statements reached strong or relative agreement during the first round, and additional rounds of votes were not conducted. The panel deliberated on various aspects such as diagnosis, differential diagnoses, disease prognosis, personalized treatment strategies, and identification of inadequate treatment responses, incorporating published evidence and expert opinions.

Conclusions: These recommendations outlined in this consensus seek to enhance the management and specific treatment protocols tailored for MOGAD patients in LATAM, with the aim of optimizing patient outcomes over long term.