Diagnosis and management of Neuromyelitis Optica Spectrum Disorder (NMOSD) in Iran: A consensus guideline and recommendations

Sahraian, Mohammad Ali; Moghadasi, Abdorreza Naser; Azimi, Amir Reza; Asgari, Nasrin; Akhoundi, Fahimeh Haji; Abolfazli, Roya; Alaie, Shekoofeh; Ashtari, Fereshteh; Ayromlou, Hormoz; Baghbanian, Seyed Mohammad; Moghadam, Nahid Beladi; Fatehi, Farzad; Foroughipour, Mohsen; Langroodi, Hamidreza Ghalyanchi; Majdinasab, Nastaran; Nickseresht, Alireza; Nourian, Abbas; Shaygannejad, Vahid; Torabi, Hamid Reza

doi:10.1016/j.msard.2017.09.015

Cited by 32 publications

(16 citation statements)

References 57 publications

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“…As NMOSD has a progressive course already from the onset of the disease, it is vital to choose an appropriate therapy that efficiently prevents further relapses to avoid clinical exacerbations leading to lasting disability [ 143 ]. Until recently, there was no approved treatment for NMOSD [ 27 ], but steroids and immunosuppressive drugs known from MS therapy were used off-label.…”

Section: Ms Medications In Nmosdmentioning

confidence: 99%

Differential Effects of MS Therapeutics on B Cells—Implications for Their Use and Failure in AQP4-Positive NMOSD Patients

Traub

Häusser‐Kinzel

Weber

2020

IJMS

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B cells are considered major contributors to multiple sclerosis (MS) pathophysiology. While lately approved disease-modifying drugs like ocrelizumab deplete B cells directly, most MS medications were not primarily designed to target B cells. Here, we review the current understanding how approved MS medications affect peripheral B lymphocytes in humans. These highly contrasting effects are of substantial importance when considering these drugs as therapy for neuromyelitis optica spectrum disorders (NMOSD), a frequent differential diagnosis to MS, which is considered being a primarily B cell- and antibody-driven diseases. Data indicates that MS medications, which deplete B cells or induce an anti-inflammatory phenotype of the remaining ones, were effective and safe in aquaporin-4 antibody positive NMOSD. In contrast, drugs such as natalizumab and interferon-β, which lead to activation and accumulation of B cells in the peripheral blood, lack efficacy or even induce catastrophic disease activity in NMOSD. Hence, we conclude that the differential effect of MS drugs on B cells is one potential parameter determining the therapeutic efficacy or failure in antibody-dependent diseases like seropositive NMOSD.

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Section: Ms Medications In Nmosdmentioning

confidence: 99%

Differential Effects of MS Therapeutics on B Cells—Implications for Their Use and Failure in AQP4-Positive NMOSD Patients

Traub

Häusser‐Kinzel

Weber

2020

IJMS

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“…In patients presenting with ON, T1-weighted gadolinium coronal images or an increase in T2-weighted MRI signal of optic nerve and optic chiasm are seen unilaterally or bilaterally, after 2 weeks of onset, and may be associated with severe vision loss. [236] Also, distinguishable diagnostic NMOSD imaging sequences include bilateral optic nerve lesions with consequent extension into optic chiasm. [108] In addition, in patients presenting with acute ON, there is a presence of enhanced and diffused T2-weighted orbital MRI signal.…”

Section: Diagnosis Of Neuromyelitis Opticamentioning

confidence: 99%

Comprehensive review of neuromyelitis optica and clinical characteristics of neuromyelitis optica patients in Puerto Rico

Zarei¹,

Eggert²,

Franqui-Dominguez³

et al. 2018

Surg Neurol Int

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Neuromyelitis optica (NMO) is an immune-mediated inflammatory disorder of the central nervous system. It is characterized by concurrent inflammation and demyelination of the optic nerve (optic neuritis [ON]) and the spinal cord (myelitis). Multiple studies show variations in prevalence, clinical, and demographic features of NMO among different populations. In addition, ethnicity and race are known as important factors on disease phenotype and clinical outcomes. There are little data on information about NMO patients in underserved groups, including Puerto Rico (PR). In this research, we will provide a comprehensive overview of all aspects of NMO, including epidemiology, environmental risk factors, genetic factors, molecular mechanism, symptoms, comorbidities and clinical differentiation, diagnosis, treatment, its management, and prognosis. We will also evaluate the demographic features and clinical phenotype of NMO patients in PR. This will provide a better understanding of NMO and establish a basis of knowledge that can be used to improve care. Furthermore, this type of population-based study can distinguish the clinical features variation among NMO patients and will provide insight into the potential mechanisms that cause these variations.

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“…The latest guidelines in the United States and Europe recommend diseasemodifying drugs (DMDs) to regulate MS [82,83] . Most recommendations for NMOSD are still based on expert advice because of the lack of clinical evidence, as until recently, most studies reporting treatment outcomes were conducted in a non-random and often retrospective environment [84][85][86] . There exist differences in the mechanisms of action, routes of administration, and approved indications of different drugs.…”

Section: Treatments In the Remission Periodmentioning

confidence: 99%

“…Since the cumulative inflammatory damage caused by acute attacks leads to disability in NMOSD, attack prevention is crucial for long-term efficacy. It is accepted that first-line immunotherapies for the prevention of relapses in NMOSD include azathioprine, mycophenolate mofetil, and rituximab [41,[84][85][86] . It should be noted that most studies on this topic were not well-controlled or randomized, and may have some bias in their results.…”

Section: Attack Prevention In Nmosdmentioning

confidence: 99%

“…Other immunosuppressants that have been used to treat NMOSD include tacrolimus, cyclophosphamide, methotrexate, and cyclosporin A. Tacrolimus and cyclosporin A produce good selective inhibition of Th cells, and methotrexate inhibits folate metabolism. However, these drugs have not been used frequently because of their uncertain effects [84][85][86] . Some studies have found that some new DMDs for MS, such as fingolimod, DMF, alemtuzumab, and natalizumab, may cause the disease to worsen, mainly in patients with AQP4-IgG-positive NMOSD [190][191][192][193][194] .…”

Section: Spms 3 Yearsmentioning

confidence: 99%

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Current immunotherapies for multiple sclerosis and neuromyelitis optica spectrum disorders: the similarities and differences

Zhang¹,

Tian²,

Li³

2019

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Diagnosis and management of Neuromyelitis Optica Spectrum Disorder (NMOSD) in Iran: A consensus guideline and recommendations

Cited by 32 publications

References 57 publications

Differential Effects of MS Therapeutics on B Cells—Implications for Their Use and Failure in AQP4-Positive NMOSD Patients

Differential Effects of MS Therapeutics on B Cells—Implications for Their Use and Failure in AQP4-Positive NMOSD Patients

Comprehensive review of neuromyelitis optica and clinical characteristics of neuromyelitis optica patients in Puerto Rico

Current immunotherapies for multiple sclerosis and neuromyelitis optica spectrum disorders: the similarities and differences

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