Managing NMOSD

The aims of current treatment options for neuromyelitis optica spectrum disorder (NMOSD) are to relieve symptoms of an acute attack and to prevent subsequent attacks (also known as relapses).1,2

Treating the symptoms that may linger following an attack can improve quality of life for patients.2,3 Such symptoms may include reduced vision, movement, bladder/bowel control, awareness and comprehension, as well as severe nausea or vomiting, tiredness, depression or pain.3,4

During an acute attack, parts of the nervous system become damaged, which can even lead to death of nerves and other cells in the nervous system.5,6 This can result in a build-up of tissue fluid and inflammation and further contributes to the nerve damage and the symptoms.6 That is why reducing this damage and suppressing the inflammation to preserve nerve function are the main goals in relieving acute attack symptoms.6

Treatment of an acute NMOSD attack usually starts with IV corticosteroids.6,7 The treatment is given by injection into a vein, usually once a day for about 3–5 days.5,6 This is commonly followed by decreasing doses of corticosteroids taken orally for a few weeks to months, depending on how severe the attack has been.5,6 The corticosteroids help to reduce the build-up of tissue fluid and inflammation at the site of nerve damage.6

The main treatment currently used for preventing relapses in the long term for patients with NMOSD is immunosuppressive therapies.3,7 These drugs target components of the immune system to suppress the immune response, dampen inflammation and thus prevent disease relapse.7

AQP4, aquaporin-4; IV, intravenous; NMOSD, neuromyelitis optica spectrum disorder.
Shi M, et al. Progress in treatment of neuromyelitis optica spectrum disorders (NMOSD): Novel insights into therapeutic possibilities in NMOSD. CNS Neurosci Ther. 2022;28(7):981–991. Trebst C, et al. Update on the diagnosis and treatment of neuromyelitis optica: recommendations of the Neuromyelitis Optica Study Group (NEMOS). J Neurol. 2014;261(1):1–16. Wingerchuk DM, Lucchinetti CF. Neuromyelitis optica spectrum disorder. N Engl J Med. 2022;387(7):631–639. Capobianco M, et al. Characterization of disease severity and stability in NMOSD: A global clinical record review with patient interviews. Neurol Ther. 2023;12(2):635–650. Jarius S, et al. Neuromyelitis optica. Nat Rev Dis Primers. 2020;6(1):85. Kessler RA, Mealy MA, Levy M. Treatment of neuromyelitis optica spectrum disorder: Acute, preventive, and symptomatic. Curr Treat Options Neurol. 2016;18(1):2. Chan KH, Lee CY. Treatment of neuromyelitis optica spectrum disorders. Int J Mol Sci. 2021;22(16):8638. Therapeutic apheresis services. Patient Information Leaflet – Plasma Exchange Procedure. NHS. Available at: https://nhsbtdbe.blob.core.windows.net/umbraco-assets-corp/1948/plasma-exchange-procedure.pdf. Last accessed: August 2023. Kleiter I, et al. Apheresis therapies for NMOSD attacks: A retrospective study of 207 therapeutic interventions. Neurol Neuroimmunol Neuroinflamm. 2018;5(6):e504. Ursani M. Intravenous immunoglobulin (IVIG). American College of Rheumatology. Available at: <https://rheumatology.org/patients/intravenous-immunoglobulin-ivig. Last accessed: August 2023.