Contemporary management challenges in seropositive NMOSD.

Area of Science:

• Neuroimmunology
• Central Nervous System Inflammatory Disorders

Background:

• Neuromyelitis optica spectrum disorder (NMOSD) is a severe autoimmune inflammatory condition of the central nervous system.
• Neurologic disability in NMOSD is primarily driven by acute relapses, making relapse prevention a critical therapeutic goal.

Purpose of the Study:

• To review current management strategies for NMOSD, focusing on relapse prevention.
• To highlight recent therapeutic advancements and ongoing challenges in NMOSD care, including biomarker discovery and equitable access to treatments.

Main Methods:

• Literature review of recent advancements in NMOSD research and clinical management.
• Analysis of the impact of aquaporin-4 immunoglobulin G (AQP4 IgG) autoantibody discovery on diagnosis and treatment.
• Discussion of emerging targeted therapies and patient-specific vulnerabilities.

Main Results:

• The discovery of AQP4 IgG has been pivotal in classifying NMOSD as an autoimmune astrocytopathy and driving therapeutic innovation.
• Approved targeted therapies (eculizumab, satralizumab, inebilizumab) show promise for AQP4 IgG-seropositive patients, but high costs are a concern.
• Seronegative NMOSD patients still face limited treatment options, underscoring a significant gap in care.

Conclusions:

• Relapse prevention remains the cornerstone of NMOSD management, necessitating further research into predictive biomarkers.
• Equitable access to novel, albeit costly, targeted therapies is essential for improving outcomes in NMOSD.
• Future research should prioritize restorative therapies and ensure broader access to effective treatments for all NMOSD patients.