Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
Department of Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
Expert Opin Biol Ther. 2022 Nov;22(11):1393-1404. doi: 10.1080/14712598.2022.2145879. Epub 2022 Nov 14.
Newly approved immunotherapies for neuromyelitis optica spectrum disorder (NMOSD) have transformed the treatment landscape and improved disability outcomes. However, there are many remaining questions regarding transitioning immunotherapies in NMOSD that have not been addressed by randomized controlled trials.
This review focuses on the practical questions of managing and switching immunotherapies for NMOSD, including how to transition between immunotherapies, deciding when and if therapy should be discontinued, and transitioning during pregnancy or breastfeeding.
Clinical experience and retrospective studies of real-world outcomes and complications associated with therapy, as well as therapy transitions, will help inform practice patterns moving forward. Strategies for transitioning between immunotherapies should consider the pharmacokinetics and the onset of clinical efficacy for each drug. Despite all the currently approved preventative immunotherapies, there are limited treatment options for those suffering from significant disability after their initial attack, and remyelination therapies are an important area for future research.
新批准的视神经脊髓炎谱系疾病（NMOSD）的免疫疗法改变了治疗格局，改善了残疾预后。然而，对于 NMOSD 中免疫疗法的转换仍有许多悬而未决的问题，这些问题尚未在随机对照试验中得到解决。
本综述重点关注 NMOSD 管理和转换免疫疗法的实际问题，包括如何在免疫疗法之间转换、何时以及是否应停止治疗，以及在怀孕期间或哺乳期进行转换。
与治疗相关的实际结果和并发症的临床经验和回顾性研究，以及治疗的转换，将有助于为未来的实践模式提供信息。在考虑免疫疗法之间的转换策略时，应考虑每种药物的药代动力学和临床疗效的出现。尽管目前有所有批准的预防性免疫疗法，但对于那些在初次发作后遭受严重残疾的患者，治疗选择有限，髓鞘再生疗法是未来研究的一个重要领域。
