A Challenging Case of MOG-Associated Optic Neuritis: The Role of IL-6 Inhibition in Refractory Disease

We present a case of a 21-year-old woman diagnosed with myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD), characterized by recurrent optic neuritis and progressive vision loss. Despite multiple immunosuppressive therapies-including corticosteroids, intravenous immunoglobulin (IVIG), azathioprine, mycophenolate mofetil, and rituximab-the patient continued to experience disabling relapses, particularly during steroid tapering. Ongoing disease activity, combined with significant steroid-related side effects, prompted a trial of subcutaneous tocilizumab, an interleukin-6 (IL-6) receptor inhibitor. Following its introduction, the patient remained relapse-free, and her steroid dose was successfully reduced. This case highlights the complexity of managing refractory MOGAD and underscores the potential role of IL-6 inhibition in treatment-resistant cases. There are sparse reports about the use of subcutaneous tocilizumab (TCZ) in MOGAD, and this case contributes to the growing body of real-world evidence supporting its use. As no standardized treatment protocol currently exists, reporting such cases is vital for advancing future therapeutic strategies and guidelines.