Neuromyelitis optica treatment: Options and more – About Your Online Magazine


Early diagnosis and treatment of neuromyelitis optica (NMO) often improves the outlook for people with this condition. Corticosteroids and immunotherapy are the main treatment options.

NMO, also known as Devic’s disease, is an autoimmune disease that affects around 4,000 people in the United States and approximately 250,000 people worldwide. There is no cure for NMO. However, early treatment can improve a person’s outlook and can even help reverse the damage that occurs during an attack.

In people with NMO, white blood cells and antibodies target the spinal cord, optic nerves, and sometimes the brain. Treatment involves dealing with current attacks and preventing future attacks. Researchers continue to look for new and improved ways to treat NMO.

The following article discusses current treatment options for NMO, as well as ongoing research and possible future treatments.

Treatment for NMO consists of two parts: addressing a current attack and preventing future attacks.

During the initial attack, a person’s health care team will attempt to control the condition and its symptoms. Treatment at this stage usually consists of intravenous corticosteroids and plasma exchange (PLEX).

More than 90% of people with NMO will have more than one attack, and these attacks are usually severe. To help prevent future attacks and disease progression, doctors often recommend ongoing treatment. This usually involves immunotherapy, which is a type of treatment that modulates the immune system.

Intravenous corticosteroids

The goal of treating an acute NMO attack is to prevent irreversible and disabling damage to the nervous system, as well as to restore its function.

O standard of care is a high dose of the intravenous corticosteroid methylprednisolone. Therapy usually involves a daily injection for 3–5 days.

Plasma exchange (PLEX)

PLEX is an NMO therapy that removes blood from the body and circulates it through a series of filters in a plasma exchange machine to remove the plasma. The machine adds artificial plasma to the remaining blood and returns this mixture to a person’s bloodstream. Doctors often use PLEX if corticosteroids are ineffective in controlling an attack.

During an acute attack, PLEX helps to lower levels of NMO-IgG – an antibody the body naturally produces – in the blood. NMO-IgG attacks the surface of supporting cells in the brain, spinal cord and optic nerves. Specialists have called damage to these cells for NMO.

PLEX even involves five sessions, each of which lasts several hours. These sessions will take place every other day and it may be necessary to repeat the therapy a few months later. The severity of the NMO attack will determine the number of PLEX sessions a person needs.

Immunotherapies

Doctors often prescribe immunotherapy to help prevent future NMO attacks. Immunotherapies suppress the immune system and reduce the inflammation that leads to NMO.

The Food and Drug Administration (FDA) has approved three drugs to treat NMO in adults who test positive for anti-aquaporin-4 (AQP4). About 70-80% of people with a positive NMO test for AQP4 antibodies.

These drugs, which received approval in 2019 and 2020, target a specific part of the immune system responsible for NMO. They include:

  • eculizumab (Soliris)
  • inebilizumab (Uplizna)
  • satralizumab-mwge (Enspryng)

Research suggests that these drugs are safe and effective and that they can significantly reduce the chances of suffering an NMO attack. They can improve neurological and functional disability assessment scores and quality of life.

Doctors also prescribe several other immunotherapies for the off-label treatment of NMO. These include:

  • azathioprine (Imuran and Azapress, among others)
  • mycophenolate mofetil (CellCept)
  • rituximab (MabThera, Rixathon, Ruxience and Truxima)

People often take azathioprine and mycophenolate mofetil along with low-dose corticosteroids.

All immunosuppressive therapies affect the immune system’s ability to fight infections. However, the benefits of these medications often outweigh the potential risks.

People who use immunosuppressive therapies can reduce the risk of getting an infection by:

  • wash your hands regularly and thoroughly with soap and water.
  • stay away from people who have an infectious disease such as the flu
  • see a doctor at the first signs of a cold or fever

Immunotherapies can cause side effects. They vary between different drugs, but common side effects include:

  • pain or swelling of the nose or throat
  • diarrhea
  • back pain
  • joint pain
  • common flu
  • throat irritation
  • bruises
  • dizziness
  • flu-like symptoms such as fever, headaches and fatigue
  • cough
  • a sore throat
  • body pain

These medications can sometimes cause more serious side effects, such as a severe infusion reaction or an allergic reaction.

Clinical trials are studies that seek to determine the efficacy and safety of new drugs and therapies. These studies play an important role in discovering effective and safe treatment options for diseases such as NMO.

A person should talk to their doctor if they are interested in participating in a clinical trial. A doctor can help determine whether a person is eligible for a trial or should avoid clinical trials because of specific health concerns.

In some cases, the doctor may be aware of ongoing studies in the field. Participating in a local study can reduce transportation costs.

People can find ongoing studies that may be recruiting participants in ClinicalTrials.gov. A person can search for neuromyelitis optica and then narrow their search to a specific area of ​​the country.

Before enrolling in a study, a person should talk to their doctor about the potential benefits and drawbacks. O International Society for Stem Cell Research recommends that individuals ask the following questions to determine if they will get what they want out of judgment:

  • What is the purpose of the trial?
  • How much will it cost or what costs can a participant expect?
  • How safe is the judgment?
  • What are the eligibility criteria?
  • What follow-up care is available?
  • What do researchers expect from participants?
  • Will participation in the study affect other health care or treatment options?

There is currently no cure for NMO. Instead, treatment focuses on resolving an attack and preventing future attacks.

Maintaining remission is critical to the overall success of a person’s treatment. ONE 2019 Study concluded that immunosuppressants can help achieve continuous remission. The authors noted that, without treatment, about 1 in 3 people with NMO will die 5 years after the first attack and 50% will go blind and need a wheelchair.

In another 2019 Study, researchers found that early diagnosis and treatment helped improve treatment outcomes and recovery in people with more severe initial attacks on the optic nerve or spinal cord.

The person should follow all of their doctor’s treatment recommendations to help prevent future attacks and maximize the chance of remission. They should talk to their doctor if they experience side effects or other problems while taking their medication.

People with NMO require immediate treatment for attacks and ongoing care to prevent future attacks. Treatment usually involves intravenous corticosteroids, PLEX, and immunotherapy.

There is currently no cure for NMO, but researchers continue to look for new and improved ways to treat and prevent NMO.

People interested in joining a clinical trial should discuss their eligibility with their physician and consider other factors such as costs and what they expect to get out of the trial.

Paula Fonseca