Proceedings of the 25th BCTRIMS Annual Meeting

Background: In January 2023 the International Panel proposed a diagnostic criteria for Myelin Oligodendrocyte Glycoprotein (MOG)-IgG associated disease (MOGAD). The criteria require the positivity for serum MOG-IgG using live or fixed cell-based assays (CBA), as well as define the groups in clear positives and low positives based on the antibody titers.  Access and reporting of the MOG-IgG assays are challenging.

Objectives: We aim to identify the status of the access to MOG-IgG assays and treatments in reference centers in Brazil.

Methods: We performed an online survey for MS neurologists in Brazil based on referral centers using the RedCap platform. Only one response per center was included. We collected information about the center and the state of origin. We investigated the availability and the type of the MOG-IgG assay and if the report included quantitative information. We also collected information about the treatment options used in MOGAD patients.

Results: We received responses from 15 centers based in 9 states: Bahia, Federal District, Paraná, Paraiba, Pernambuco, Rio de Janeiro, Rio Grande do Sul, Santa Catarina and São Paulo. We found the availability of the MOG-IgG assays in their local labs is 23.5%, with 17.6% reporting no access to the tests.  All centers had access to aquaporin-4 IgG for the diagnosis of neuromyelitis optica spectrum disorder. Just 13.3% reported ELISA or WB for testing MOG-IgG. The MOG-IgG titers were reported in 40% of the centers and positive/negative results in 46.7%. Most centers start chronic treatments only after a relapse, such as rituximab, immunoglobulin, oral steroids, and/or oral immunosuppressive drugs.

Conclusions: We found that there is a lack of MOG-IgG assays availability in local labs. There is still use of not recommended methods such as ELISA for MOG-IgG increasing the risk of a false positivity. The MOG-IgG titers or clear/low positive reporting is low.