From the Research
The treatment for neuromyelitis optica (NMO) should prioritize the use of high-dose intravenous methylprednisolone for acute attacks, followed by long-term immunosuppressive therapy with newer monoclonal antibodies like eculizumab, ravulizumab, inebilizumab, or satralizumab to prevent relapses, as recommended by the most recent guidelines 1. The management of NMO involves both acute and long-term strategies. During acute attacks, high-dose intravenous methylprednisolone is the first-line treatment, often followed by a tapering course of oral prednisone. For severe attacks or when steroid response is inadequate, plasma exchange may be necessary.
- Key points in acute management:
- High-dose intravenous methylprednisolone (typically 1000 mg daily for 3-5 days)
- Plasma exchange (5-7 exchanges over 1-2 weeks) for severe attacks or inadequate steroid response For long-term prevention of relapses, the use of monoclonal antibodies has become a preferred approach due to their targeted mechanism of action and the results from recent randomized controlled trials.
- Long-term immunosuppressive therapy options:
- Eculizumab
- Ravulizumab
- Inebilizumab
- Satralizumab These treatments are preferred over traditional immunosuppressants like azathioprine and mycophenolate mofetil due to their specificity for the disease mechanisms involved in NMO, as highlighted in the latest update on the diagnosis and treatment of neuromyelitis optica spectrum disorders 1. Regular monitoring with MRI and clinical assessments is essential to evaluate treatment response and detect relapses early, emphasizing the importance of a multidisciplinary approach in the management of NMO.