MOGAD: A Shifting Landscape—From Pathogenesis to Personalised Management, Global Perspectives and Latin American Insights

Abstract

Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) has emerged as a distinct autoimmune demyelinating disorder, characterised by clinical, radiological, and immunopathological features that differentiate it from Multiple Sclerosis (MS) and AQP4+ neuromyelitis optica spectrum disorder (AQP4+NMOSD). This review provides a comprehensive synthesis of the evolving landscape of MOGAD, from its immunopathogenesis and diagnostic criteria to treatment strategies and global epidemiological insights. We explore the role of MOG-IgG antibodies in disease mechanisms, the utility of emerging biomarkers, and the prognostic value of tools like clinical scores or longitudinal MOG-IgG assessment. Special attention is given to regional disparities, with a focus on Latin America, highlighting diagnostic delays, access inequities, and unique clinical phenotypes. We also examine the limitations of current evidence, including gaps in long-term longitudinal follow-up and variability in diagnostic testing. Finally, we discuss global collaborative efforts and clinical trials that are shaping the future of personalised care in MOGAD. As the field advances, integrating biomarker-driven monitoring, equitable access to therapies, and regionally adapted guidelines will be essential to improving outcomes for patients worldwide.