Analysis of Pregnancy-Related Attacks in Neuromyelitis Optica Spectrum Disorder

Wang, Liang; Su, Manqiqige; Zhou, Zhirui; Zhou, Lei; ZhangBao, Jingzi; Tan, Hongna; Huang, Wenjuan; Chang, Xuechun; Lü, Chuan-Zhen; Yu, Jian; Wang, Min; Lu, Jiahong; Zhao, Chongbo; Zhang, Tiansong; Quan, Chao

doi:10.1001/jamanetworkopen.2022.25438

Cited by 10 publications

(8 citation statements)

References 40 publications

(218 reference statements)

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“…Depending on the symptomatology, patients suffer from marked disabilities, sometimes even life-threatening situations (respiratory fail-main topic ure) [3]. During pregnancy, relapses (unlike MS) are not uncommon [27].…”

Section: Clinical Manifestationsmentioning

confidence: 99%

Treatment of neuromyelitis optica spectrum disorder: revisiting the complement system and other aspects of pathogenesis

Ponleitner

2022

Wien Med Wochenschr

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SummaryNeuromyelitis optica spectrum disorder (NMOSD) represents a rare neuroimmunological disease causing recurrent attacks and accumulation of permanent disability in affected patients. The discovery of the pathogenic IgG‑1 antibody targeting a water channel expressed in astrocytes, aquaporin 4, constitutes a milestone achievement. Subsequently, multiple pathophysiological aspects of this distinct disease entity have been investigated. Demyelinating lesions and axonal damage ensue from autoantibodies targeting an astroglial epitope. This conundrum has been addressed in the current disease model, where activation of the complement system as well as B cells and interleukin 6 (IL-6) emerged as key contributors. It is the aim of this review to address these factors in light of novel treatment compounds which reflect these pathophysiological concepts in aiming for attack prevention, thus reducing disease burden in patients with NMOSD.

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Section: Clinical Manifestationsmentioning

confidence: 99%

Treatment of neuromyelitis optica spectrum disorder: revisiting the complement system and other aspects of pathogenesis

Ponleitner

2022

Wien Med Wochenschr

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“…The available evidence on fetal outcomes in NMOSD patients is scarce. In a systematic review and meta-analysis neonatal complications, including low birth weight and stillbirth, were described in 33/619 (5.3%) of the informative pregnancies ( 41 ). Among these, immunosuppressive treatment during pregnancy was associated with neonatal complications in 13 events.…”

Section: Aquaporin-4 Antibody Neuromyelitis Optica Spectrum Disordersmentioning

confidence: 99%

“…Patients had a reduced risk of relapse during pregnancy in each serostatus group when compared to the pre-pregnancy period, while the annualized relapse rate was higher during the first postpartum trimester only in AQP4-Ab positive women ( 16 ). Factors associated with a reduced risk of NMOSD attacks were: being on an immunosuppressive treatment during pregnancy and an older age at conception ( 7 , 41 , 43 , 44 ).…”

Section: Aquaporin-4 Antibody Neuromyelitis Optica Spectrum Disordersmentioning

confidence: 99%

“…Considering the effect of pregnancy on the course of NMOSD, especially in the postpartum period, the immunosuppressive treatment choice before conception and the decision to stop or continue these drugs during pregnancy and after delivery requires careful evaluation. Immunosuppressant treatment discontinuation or insufficient immunosuppression have been proposed as risk factors for NMOSD attacks during or soon after pregnancy ( 7 , 41 , 44 ). Yet, NMOSD treatments may be harmful to the fetus and many lack adequate safety data in this population.…”

Section: Aquaporin-4 Antibody Neuromyelitis Optica Spectrum Disordersmentioning

confidence: 99%

“…In the future, it would be useful to identify factors associated with pregnancy-related relapses in MOGAD, as has been done for AQP4+NMOSD ( 41 ). Prospective studies with large sample size are needed to evaluate if clinical features (e.g., different phenotypes at onset, number and recovery of relapses, age at conception, treatment) or Ab-characteristics (titers, timing and persistence over time) may be independent risk factors for pregnancy-related relapses.…”

Section: Myelin-oligodendrocyte Glycoprotein Antibody-associated Diseasementioning

confidence: 99%

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Pregnancy and antibody-mediated CNS disorders: What do we know and what should we know?

et al. 2022

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Antibody-mediated central nervous system (CNS) disorders including those associated with aquaporin-4 or myelin oligodendrocyte glycoprotein IgG and autoimmune encephalitis often affect women of childbearing age. Pathogenic antibodies of these diseases can potentially alter reproductive functions and influence fetal development. Hormonal changes occurring during pregnancy may modify the course of autoimmune diseases by influencing relapse risk, attack severity, and affect the delivery and postpartum period. Moreover, balancing treatment related safety issues with the risk of potentially disabling relapses during pregnancy and breastfeeding are major challenges. Intentional prenatal, gestational, and post-partum counseling is paramount to address these issues and mitigate these risks. Fortunately, new insights on risk factors for adverse pregnancy outcomes and possible preventive strategies are emerging. This review aims to summarize the interplay between antibody-mediated CNS disorders and pregnancy during the prenatal, gestational, and postpartum periods, highlight current treatment recommendations, and discuss future areas of research.

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Update on the diagnosis and treatment of neuromyelitis optica spectrum disorders (NMOSD) – revised recommendations of the Neuromyelitis Optica Study Group (NEMOS). Part II: Attack therapy and long-term management

Kuempfel¹,

Giglhuber²,

Aktaş³

et al. 2023

J Neurol

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This manuscript presents practical recommendations for managing acute attacks and implementing preventive immunotherapies for neuromyelitis optica spectrum disorders (NMOSD), a rare autoimmune disease that causes severe inflammation in the central nervous system (CNS), primarily affecting the optic nerves, spinal cord, and brainstem. The pillars of NMOSD therapy are attack treatment and attack prevention to minimize the accrual of neurological disability. Aquaporin-4 immunoglobulin G antibodies (AQP4-IgG) are a diagnostic marker of the disease and play a significant role in its pathogenicity. Recent advances in understanding NMOSD have led to the development of new therapies and the completion of randomized controlled trials. Four preventive immunotherapies have now been approved for AQP4-IgG-positive NMOSD in many regions of the world: eculizumab, ravulizumab - most recently-, inebilizumab, and satralizumab. These new drugs may potentially substitute rituximab and classical immunosuppressive therapies, which were as yet the mainstay of treatment for both, AQP4-IgG-positive and -negative NMOSD. Here, the Neuromyelitis Optica Study Group (NEMOS) provides an overview of the current state of knowledge on NMOSD treatments and offers statements and practical recommendations on the therapy management and use of all available immunotherapies for this disease. Unmet needs and AQP4-IgG-negative NMOSD are also discussed. The recommendations were developed using a Delphi-based consensus method among the core author group and at expert discussions at NEMOS meetings.

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Analysis of Pregnancy-Related Attacks in Neuromyelitis Optica Spectrum Disorder

Cited by 10 publications

References 40 publications

Treatment of neuromyelitis optica spectrum disorder: revisiting the complement system and other aspects of pathogenesis

Treatment of neuromyelitis optica spectrum disorder: revisiting the complement system and other aspects of pathogenesis

Pregnancy and antibody-mediated CNS disorders: What do we know and what should we know?

Update on the diagnosis and treatment of neuromyelitis optica spectrum disorders (NMOSD) – revised recommendations of the Neuromyelitis Optica Study Group (NEMOS). Part II: Attack therapy and long-term management

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