ECTRIMS 2022 | Current diagnostic and treatment measures for AQP4-IgG-positive NMOSD

Kazuo Fujihara, MD, PhD, Fukushima Medical University School of Medicine, Fukushima, Japan, presents an overview of the diagnosis, prevention, and treatment of neuromyelitis optica spectrum disorder (NMOSD). Historically misdiagnosed as multiple sclerosis (MS), NMOSD is a chronic inflammatory autoimmune disease that occurs mainly in the optic nerve and spinal cord, but also in other areas of the central nervous system (CNS). In many patients, the aquaporin-4 (AQP4)-IgG antibody is detectable and is associated with relapsing disease. In terms of treating AQP4-positive NMOSD (AQP4+NMOSD), high-dose corticosteroids are typically the first-line treatment; however, if the patient responds poorly to corticosteroids, plasma exchange is recommended as an alternative. Preventing AQP4+NMOSD relapses is the next important step, as relapses can be disabling to patients. Three monoclonal antibodies have been FDA-approved for the treatment of AQP4+NMOSD, including eculizumab, inebilizumab, and satralizumab. However, the long-term effects of these drugs, including how long treatment should be offered, are currently under investigation. Other new studies concerning stem cell transplants and improving the immune tolerance of patients have shown varying results. Prof. Fujihara expresses the need for further clinical trials in these new technologies as well as the development of personalized medicine for the future treatment of AQP4+NMOSD. This interview took place at the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) Congress 2022 in Amsterdam, The Netherlands.

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