A Clinical Approach to Existing and Emerging Therapeutics in Neuromyelitis Optica Spectrum Disorder

Purpose of Review Neuromyelitis optica spectrum disorder (NMOSD) is a rare but highly disabling disease of the central nervous system. Unlike multiple sclerosis, disability in NMOSD occurs secondary to relapses that, not uncommonly, lead to blindness, paralysis, and death. Recently, newer, targeted...

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Bibliographic Details
Published in:Current neurology and neuroscience reports 2023-09, Vol.23 (9), p.489-506
Main Authors: Yong, Heather Y. F., Burton, Jodie M.
Format: Article
Language:English
Subjects:
Antibodies
Aquaporins
Bone marrow
Central nervous system
Clinical trials
COVID-19
Cytotoxicity
Immunoglobulins
Immunotherapy
Lymphocytes
Medicine
Medicine & Public Health
Morbidity
Multiple sclerosis
Nervous system
Neurology
Neuromyelitis
Neurosciences
Observational studies
Paralysis
Pathogenesis
Patients
Remission (Medicine)
Rituximab
Severe acute respiratory syndrome coronavirus 2
Systematic review
Topical Collection on Demyelinating Disorders
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Summary:Purpose of Review Neuromyelitis optica spectrum disorder (NMOSD) is a rare but highly disabling disease of the central nervous system. Unlike multiple sclerosis, disability in NMOSD occurs secondary to relapses that, not uncommonly, lead to blindness, paralysis, and death. Recently, newer, targeted immunotherapies have been trialed and are now in the treatment arsenal. We have endeavoured to evaluate the current state of NMOSD therapeutics. Recent Findings This review provides a pragmatic evaluation of recent clinical trials and post-marketing data for rituximab, inebilizumab, satralizumab, eculizumab, and ravalizumab, contrasted to older agents. We also review contemporary issues such as treatment in the context of SARS-CoV2 infection and pregnancy. Summary There has been a dramatic shift in NMOSD morbidity and mortality with earlier and improved disease recognition, diagnostic accuracy, and the advent of more effective, targeted therapies. Choosing a maintenance therapy remains nuanced depending on patient factors and accessibility. With over 100 putative agents in trials, disease-free survival is now a realistic goal for NMOSD patients.
ISSN:1528-4042
1534-6293
DOI:10.1007/s11910-023-01287-x