Treatment of NMOSD using case studies
ECTRIMS Online Library. Palace J. Oct 12, 2018; 232033; 280
Jacqueline Palace
Jacqueline  Palace
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Abstract: 280

Type: Educational Session

Abstract Category: N/A

Because the majority of patients with neuromyelitis spectrum disorders (NMOSD) have auto-antibodies to aquaporin-4 (AQP4) water channels or, more recently described, myelin oligodendroctye glycoprotein (MOG), the treatment is similar to that of other autoantibody diseases. In contrast to multiple sclerosis the disability is solely relapse related and often severe, thus the treatment focuses on aggressive and urgent management of relapses and then rather than partial relapse reduction, the aim is relapse prevention. The evidence base behind the optimal treatment regime is lacking and current treatments are not specifically licensed for this syndrome.
Acute relapses are usually treated with high dose IV methylprednisolone, which should be given early in order to maximise recovery. If there is a poor response then a further course, or plasma exchange or intravenous immunoglobulin should be tried.
Because AQP4 antibodies are associated with relapsing disease, relapse prevention should be started. Prednisolone, azathioprine, rituximab, mycophenolate mofetil (MM), methotrexate, are amongst the immunosuppressive therapies commonly used. Prednisolone may be combined with other steroid sparing agents and there is observational evidence that there is increasing efficacy in order across the three following drugs: azathioprine, MM and rituximab.
Antibody negative NMOSD and MOG antibody disease may be monophasic, thus relapse prevention is generally not given for a single attack, although a course of prednisolone to cover the early period when rebound/early relapse can occur, may be given.
Case studies to highlight important management principles will be used, and will include pregnancy specific issues and whether antibody titres are useful.
Disclosure: Nothing to disclose

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