Future treatments for myelin oligodendrocyte glycoprotein antibody-associated disease: the clinical trial landscape

INTRODUCTION: Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is an emerging autoimmune demyelinating disorder distinct from multiple sclerosis and AQP4-IgG-positive neuromyelitis optica. Despite increasing recognition, no therapies are currently approved for MOGAD, and treatment remains empirical, with significant variability in clinical response and access to care. AREAS COVERED: This review explores the evolving treatment landscape of adult MOGAD, with a focus on immunotherapies under active clinical investigation: azathioprine, tocilizumab, satralizumab, and rozanolixizumab. For each agent, we discuss mechanisms of action, pharmacokinetics, dosing, safety, and efficacy based on clinical trials and observational data. Literature was identified through PubMed and ClinicalTrials.gov, including ongoing phase 2/3 studies (MOGwAI, TOMATO, METEOROID, and cosMOG). EXPERT OPINION: Targeted immunotherapies have the potential to transform MOGAD management. In the next five years, one or more of these agents may achieve regulatory approval, particularly if biomarker-driven strategies and trial designs are refined. Addressing unmet needs in pediatric populations and low-resource settings will be essential to ensure equitable, personalized treatment.