Please ensure JavaScript is enabled for purposes of website accessibility NMOSD Treatment Guidelines | Evolving Beyond Attack Reduction | For HCPs

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Approved therapies allow for evidence-based medicine and tailoring treatment to a patient’s specific needs1,2

Treatment considerations should now involve more than attack reduction alone1,3

No-FDA-approved-therapies

Prior to 2019, no FDA-approved therapies existed for NMOSD3

  • None of the commonly used agents (AZA, MMF, or rituximab) had been proven effective in a rigorous clinical trial4
  • Rituximab may have reduced efficacy in patients with a genetic risk factor that results in reduced IgG binding5
nmosd-attack-adjudication-varied-icon

Criteria for attack adjudication varied among the 3 FDA-approved treatments6

  • Results of the 4 pivotal trials in NMOSD are not comparable, given different definitions of attack, adjudication processes, and other considerations6
  • The 3 currently FDA-approved NMOSD treatments differ in MOA, dosing frequency, and method of administration7,8a
evolving-treatment-goals-icon

Treatment goals are evolving3

  • Criteria for selecting treatment should include efficacy, problems with current treatment (side effects), dosing frequency, potential for adherence, and safety3

ECTRIMS 2022 invited a panel of international NMOSD experts to develop validated statements on the management of AQP4-IgG+ NMOSD through the Delphi consensus process.2

This panel agreed that

  • Monotherapy is preferable to reduce the risk of additional side effects with concomitant use of other immunosuppressant therapies2
  • For newly diagnosed patients, choice of therapy may be informed by patient preferences in dosing frequency, route of administration, and acceptance of potential safety risks, including during pregnancy2
  • Severe relapses, serious treatment-related adverse events, and patient preference for another therapy should all warrant switching treatment2
  • Vaccinations should be kept up to date, with additional guidance concerning meningococcal vaccination when prescribing eculizumab2
Learn about an NMOSD treatment option

Defining attacks with methods of monitoring Methods of Monitoring

aThese treatments have not been studied in head-to-head clinical trials.

AZA, azathioprine; ECTRIMS, European Committee for Treatment and Research in Multiple Sclerosis; MMF, mycophenolate mofetil; MOA, mechanism of action.

  • References

    1. Held F, Klein A-K, Berthele A. Drug treatment of neuromyelitis optica spectrum disorders: out with the old, in with the new? Immunotargets Ther. 2021;10:87-101.
    2. Paul F, Marignier R, Palace J; on behalf of the NMOSD Delphi Panel. International, evidence-based Delphi consensus on the management of AQP4-IgG positive NMOSD, with a focus on treatment recommendations for eculizumab, inebilizumab and satralizumab. Poster P008 presented at: ECTRIMS 2022 (Amsterdam): October 25-28, 2022.
    3. Wingerchuk DM, Lucchinetti CF. Neuromyelitis optica spectrum disorder. N Engl J Med. 2022;387:631-639. doi:10.1056/NEJMra1904655
    4. Kessler RA, Mealy MA, Levy M. Treatment of neuromyelitis optica spectrum disorder: acute, preventive, and symptomatic. Curr Treat Options Neurol. 2016;18(1):1-15. doi:10.1007/s11940-015-0387-9
    5. Kim S-H, Jeong IH, Hyun J-W, et al. Treatment outcomes with rituximab in 100 patients with neuromyelitis optica: influence of FCGR3A polymorphisms on the therapeutic response to rituximab. JAMA Neurol. 2015;72(9):989-995. doi:10.1001/jamaneurol.2015.1276
    6. Cree BAC, Greenberg B, Cameron C, Weinshenker BG. Letter to the editor regarding ‘‘Network meta-analysis of Food and Drug Administration-approved treatment options for adults with aquaporin-4 immunoglobulin G-positive neuromyelitis optica spectrum disorder.” Neurol Ther. 2022;11:1439-1443.
    7. SOLIRIS® (eculizumab) [prescribing information]. Alexion Pharmaceuticals, Inc.
    8. ENSPRYNG® (satralizumab-mwge) [prescribing information]. Genentech, Inc.