| Intervention | Indication/setting | Mechanism/class | Typical regimen/dose (as available) | Evidence/outcomes | Trial identifiers/status (if any) | Source (URL, year) with pqac citations |
|---|---|---|---|---|---|---|
| IV methylprednisolone (IVMP) | First-line acute treatment for ADEM; also used in MOGAD/MOG-related ADEM attacks | High-dose corticosteroid; broad anti-inflammatory and immunosuppressive therapy | 1–2 g/day for 3–5 days then oral taper in adults/reviews; pediatric dosing commonly 30 mg/kg/day (max 1000 mg) for 3–5 days, followed by oral prednisone taper over 4–6 weeks (pqac-00000027, pqac-00000028, pqac-00000029, pqac-00000030) | Favorable response in about two-thirds of cases; steroids shorten disease duration and halt progression; early treatment associated with better outcomes; rapid taper/early discontinuation may increase relapse risk in MOGAD/ADEM-spectrum disease (pqac-00000027, pqac-00000028, pqac-00000029, pqac-00000036) | Standard of care; no dedicated ADEM RCT retrieved | Stoian et al. https://doi.org/10.3390/vaccines11071225 (2023); Paolilo et al. https://doi.org/10.3390/children7110210 (2020); Mahapure et al. https://doi.org/10.4103/ajns.ajns_406_20 (2021); Vempati et al. https://doi.org/10.7759/cureus.42070 (2023) (pqac-00000027, pqac-00000028, pqac-00000029, pqac-00000030) |
| Oral corticosteroid taper after IVMP | Post-acute ADEM and MOGAD-related ADEM to reduce rebound/relapse | Corticosteroid continuation/taper | Prednisone taper over 4–6 weeks commonly recommended; in one MOGAD-related source, relapse trends noted when prednisolone dropped below 10 mg/day within 2 months (pqac-00000028, pqac-00000036) | Used routinely in practice; slower taper in MOG-seropositive pediatric ADEM was observed, but relapse risk remained higher in that group (pqac-00000040) | Standard practice; no dedicated trial retrieved | Paolilo et al. https://doi.org/10.3390/children7110210 (2020); Misu https://doi.org/10.3390/ijms26178538 (2025); Dong et al. https://doi.org/10.3389/fnins.2023.1128422 (2023) (pqac-00000028, pqac-00000036, pqac-00000040) |
| IVIG | Second-line or adjunctive therapy for steroid-unresponsive ADEM; part of first-line immunotherapy set in suspected immune-mediated MOG-Ab encephalitis | Pooled immunoglobulin; immunomodulatory | Total dose 2 g/kg over 2–5 days in review guidance; COVID-ADEM reviews also describe IVIG as next-line after steroids (pqac-00000028, pqac-00000029) | Generally well tolerated; used for steroid-unresponsive, recurrent, or steroid-dependent disease; in pediatric MOG-Ab encephalitis, should not be delayed once infections are reasonably excluded and immune-mediated disease suspected (pqac-00000028, pqac-00000029, pqac-00000031) | Standard practice; no dedicated ADEM IVIG trial retrieved | Paolilo et al. https://doi.org/10.3390/children7110210 (2020); Mahapure et al. https://doi.org/10.4103/ajns.ajns_406_20 (2021); Kim et al. https://doi.org/10.1212/nxi.0000000000200323 (2024) (pqac-00000028, pqac-00000029, pqac-00000031) |
| Plasma exchange / therapeutic plasma exchange (PLEX/TPE) | Escalation therapy for severe or steroid-refractory ADEM; also considered in severe MOGAD attacks | Apheresis; removal of pathogenic antibodies, immune complexes, cytokines | In classic RCT, exchanges every 2 days for 7 exchanges; pediatric series often 4–5 sessions after steroid/IVIG failure (pqac-00000032, pqac-00000051) | Recommended when inadequate response to steroids/IVIG; mixed neuroimmunology series reported immediate improvement in 95% and sustained significant improvement in 78% at follow-up; small pediatric ADEM series showed progressive clinical improvement in all patients, though some retained deficits (pqac-00000032, pqac-00000033) | NCT00004645, Phase 3, randomized double-blind sham-controlled, status unknown/previously active-not-recruiting; included ADEM among acute severe inflammatory demyelinating attacks refractory to IVMP (pqac-00000051) | Bhardwaj et al. https://doi.org/10.7759/cureus.64190 (2024); ClinicalTrials.gov NCT00004645 (1995) (pqac-00000032, pqac-00000033, pqac-00000051) |
| Early first-line immunotherapy bundle (steroids, IVIG, plasma exchange) | Pediatric suspected MOG-Ab encephalitis/ADEM spectrum, including initially normal MRI | Acute immunosuppression strategy | No single fixed regimen; recommendation is to start first-line immunotherapy once HSV PCR/Gram stain are negative and infection no longer explains presentation (pqac-00000031) | Real-world implication: many children were initially misdiagnosed as infective meningoencephalitis (67%); delayed steroids were associated with encephalitis phenotype compared with ADEM phenotype (median 16.6 vs 9.6 days) (pqac-00000031) | Not a trial; practice recommendation from multicenter cohort | Kim et al. https://doi.org/10.1212/nxi.0000000000200323 (2024) (pqac-00000031) |
| Azathioprine | Relapse prevention after first MOGAD attack / recurrent MOGAD including MOG-related ADEM phenotypes | Purine antimetabolite immunosuppressant | Trial dosing: 100 mg/day if ≤50 kg and 150 mg/day if >50 kg, orally, plus associated prednisone taper over 6 months (pqac-00000053) | Trial aims to determine whether early azathioprine prevents relapse and disability accrual; secondary outcomes include EDSS, visual outcomes, MRI lesions, QoL, and MOG-Ab titers (pqac-00000053) | NCT05349006, Phase 3, RECRUITING, estimated enrollment 126 (pqac-00000053) | ClinicalTrials.gov NCT05349006 (2023) (pqac-00000053) |
| Satralizumab | MOGAD relapse prevention in adolescents/adults, relevant to relapsing MOG-related ADEM phenotypes | Anti-IL-6 receptor monoclonal antibody | Subcutaneous loading at weeks 0, 2, 4, then every 4 weeks; monotherapy or add-on to baseline therapy (pqac-00000054) | Primary outcome is time to first adjudicated MOGAD relapse; key secondary outcomes include ARR, active MRI lesions, rescue therapy use, and hospitalization rate (pqac-00000054) | NCT05271409 (Meteoroid), Phase 3, RECRUITING, estimated enrollment 152 (pqac-00000054) | ClinicalTrials.gov NCT05271409 (2022) (pqac-00000054) |
| Rozanolixizumab | Adult MOGAD relapse prevention, applicable to relapsing MOG-related ADEM spectrum | FcRn inhibitor reducing pathogenic IgG | Subcutaneous infusion/administration in randomized placebo-controlled design; exact dose not given in retrieved chunk (pqac-00000052) | Primary endpoint is time to first centrally adjudicated relapse; secondary measures include EDSS, low-contrast visual acuity, hospitalizations, ARR, and TEAEs (pqac-00000052) | NCT05063162 (cosMOG), Phase 3, ACTIVE_NOT_RECRUITING, enrollment 113 (pqac-00000052) | ClinicalTrials.gov NCT05063162 (2022) (pqac-00000052) |
| Tocilizumab | MOGAD patients, generally for relapse prevention or refractory disease | Anti-IL-6 receptor monoclonal antibody | Regimen not available in retrieved chunk | Trial listed as evaluating safety and efficacy in MOGAD; detailed endpoints not retrieved in current context (from clinical trial search summary) | NCT06452537, Phase 2/3, ACTIVE_NOT_RECRUITING, enrollment 102 | ClinicalTrials.gov NCT06452537 (trial registry summary from search results) (pqac-00000057) |
| High-throughput omics biomarker study (blood/PBMC profiling) | First demyelinating attack in children to predict relapse in ADEM/MOGAD network | Biomarker discovery / immune-cell multi-omics | Serial blood collection at inclusion, 6 months, and 24 months; PBMC sampling before immunomodulatory treatment for retrospective inclusions (pqac-00000050) | Objective is early identification of biomarkers predicting MOGAD recurrence after first attack; outcomes include EDSS and number/type of demyelinating relapses (pqac-00000050) | NCT06863974 (HOT-BRAIN), interventional, RECRUITING, enrollment 20 (pqac-00000050) | ClinicalTrials.gov NCT06863974 (2025) (pqac-00000050) |


*Table: This table summarizes acute real-world treatment strategies for ADEM and MOGAD-related ADEM, including escalation approaches and selected ongoing or recent clinical trials. It is useful for connecting current standard care with emerging targeted and biomarker-driven interventions.*