Progress in treatment of neuromyelitis optica spectrum disorders (NMOSD): Novel insights into therapeutic possibilities in NMOSD

Abstract

Neuromyelitis optica spectrum disorder (NMOSD) is a rare autoimmune inflammatory demyelinating disorder of the central nervous system (CNS), which is a severely disabling disorder leading to devastating sequelae or even death. Repeated acute attacks and the presence of aquaporin‐4 immunoglobulin G (AQP4‐IgG) antibody are the typical characteristics of NMOSD. Recently, the phase III trials of the newly developed biologicals therapies have shown their effectiveness and good tolerance to a certain extent when compared with the traditional therapy with the first‐ and second‐line drugs. However, there is still a lack of large sample, double‐blind, randomized, clinical studies to confirm their efficacy, safety, and tolerability. Especially, these drugs have no clear effect on NMOSD patients without AQP4‐IgG and refractory patients. Therefore, it is of strong demand to further conduct large sample, double‐blind, randomized, clinical trials, and novel therapeutic possibilities in NMOSD are discussed briefly here.

Perspectives on Neuromyelitis Optica Spectrum Disorders, the Narrative Medicine contribution to care

“…Considering the three different points of view, substantial alignment emerged from the narratives of patients and caregivers, whose main expectation is improvement in the physical condition and an effective cure in 50% and 64% of narratives, respectively. Eighty-five percent of professional narratives, instead, showed satisfaction with the therapeutic option and caring relationships offered, confirming what was already observed in other conditions [ 26 ].…”

Aquaporin 4 antibody‐positive neuromyelitis optica spectrum disorder with cholangiocarcinoma: Casual or causal association?

“…Immunosuppressive agents have been prescribed to prevent future recurrence, including azathioprine, mycophenolate mofetil, rituximab, or tocilizumab. 10 Whereas, improvement of neurological symptoms after acute-phase corticosteroids and oncotherapy without further immunotherapy has been described. 3 Additionally, a recent systematic review discovered that tumor resection had a significant relationship with complete recovery at the first attack and fewer relapses during follow-up in patients with concomitant cancers.…”

Frequency of new asymptomatic MRI lesions during attacks and follow-up of patients with NMOSD in a real-world setting

“…1,3 In consequence, the disease requires long-term immunosuppression to reduce the high rate of relapse related disability. 1–5…”

“…1,3 In consequence, the disease requires longterm immunosuppression to reduce the high rate of relapse related disability. [1][2][3][4][5] Brain abnormalities on magnetic resonance imaging (MRI) have been described in up to 80% of NMOSD patients at presentation, and around 50% are suggestive or typical of NMOSD. [1][2][3] Longitudinally extensive transverse myelitis (LETM) lesions on spinal cord MRI have been reported in up to 70% of NMOSD patients, while short-segment myelitis (STM) lesions in around 20% of them.…”