Recommendations on NMOSD treatment in Latin America: Utilizing consensus-based RAND/UCLA methodology

Area of Science:

• Neurology
• Immunology
• Clinical Medicine

Background:

• Neuromyelitis optica spectrum disorder (NMOSD) is a severe autoimmune condition with global impact.
• Latin America faces unique challenges in NMOSD treatment access due to healthcare disparities and economic factors.
• Optimizing therapeutic decision-making, including preventive therapies, is crucial for effective NMOSD management worldwide.

Purpose of the Study:

• To develop evidence-based treatment guidelines for Neuromyelitis optica spectrum disorder (NMOSD) patients in Latin America.
• To establish validated consensus statements on NMOSD management through a structured expert process.

Main Methods:

• A panel of Latin American NMOSD experts participated in a consensus process.
• The RAND/UCLA methodology was used, with experts voting on statements using a 9-point Likert scale.
• A consensus threshold of 70% expert agreement was required for statement validation.

Main Results:

• Thirty-one consensus statements were agreed upon by 19 experts between March and April 2023.
• Statements covered general NMOSD management recommendations (14/31) and specific clinical scenarios (17/31).
• Clinical scenarios addressed treatment-naive AQP4-positive and seronegative NMOSD, treatment switching, and safety considerations.

Conclusions:

• Consensus recommendations for key NMOSD treatment areas were successfully developed by Latin American experts.
• These statements provide a valuable framework for clinical decision-making in NMOSD.
• The recommendations serve as a foundation for standardizing practice guidelines in the region to improve patient outcomes.