Treatment of neuromyelitis optica: Review and recommendations

• DOI: 10.1016/j.msard.2012.06.002
• Publication Date: 2012-07-31T09:01:29Z
• Authors: Dorlan J. Kimbrough; Kazuo Fujihara; Anu Jacob; Marco A. Lana-Pei...; Maria Isabel Leite; Michael Levy; Romain Marignier; Ichiro Nakashima; Jacqueline Palace; Jérôme de Seze; Olaf Stuve; Silvia N. Tenembaum; Anthony Traboulsee; Emmanuelle Waubant; Brian G. Weinshenker; Dean M. Wingerchuk
• Keywords: 03 medical and health sciences; 0302 clinical medicine; 3. Good health

Neuromyelitis optica (NMO) is an autoimmune demyelinating disease preferentially targeting the optic nerves and spinal cord. Once regarded as a variant of multiple sclerosis (MS), NMO is now recognized to be a different disease with unique pathology and immunopathogenesis that does not respond to traditional MS immunomodulators such as interferons. Preventive therapy in NMO has focused on a range of immunosuppressive medications, none of which have been validated in a rigorous randomized trial. However, multiple retrospective and a few recent prospective studies have provided evidence for the use of six medications for the prevention of NMO exacerbations: azathioprine, rituximab, mycophenolate mofetil, prednisone, methotrexate and mitoxantrone. This review provides a comprehensive analysis of each of these medications in NMO and concludes with a set of recommended consensus practices.