Division of Neurology, Department of Clinical Neurosciences, University of Calgary, Cummings School of Medicine, Calgary, AB, Canada.
Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
Curr Neurol Neurosci Rep. 2023 Sep;23(9):489-506. doi: 10.1007/s11910-023-01287-x. Epub 2023 Aug 4.
Neuromyelitis optica spectrum disorder (NMOSD) is a rare but highly disabling disease of the central nervous system. Unlike multiple sclerosis, disability in NMOSD occurs secondary to relapses that, not uncommonly, lead to blindness, paralysis, and death. Recently, newer, targeted immunotherapies have been trialed and are now in the treatment arsenal. We have endeavoured to evaluate the current state of NMOSD therapeutics.
This review provides a pragmatic evaluation of recent clinical trials and post-marketing data for rituximab, inebilizumab, satralizumab, eculizumab, and ravalizumab, contrasted to older agents. We also review contemporary issues such as treatment in the context of SARS-CoV2 infection and pregnancy. There has been a dramatic shift in NMOSD morbidity and mortality with earlier and improved disease recognition, diagnostic accuracy, and the advent of more effective, targeted therapies. Choosing a maintenance therapy remains nuanced depending on patient factors and accessibility. With over 100 putative agents in trials, disease-free survival is now a realistic goal for NMOSD patients.
视神经脊髓炎谱系疾病（NMOSD）是一种罕见但高度致残的中枢神经系统疾病。与多发性硬化症不同，NMOSD 的残疾是继发于复发的，这些复发并不罕见地导致失明、瘫痪和死亡。最近，已经尝试了新的靶向免疫疗法，并且现在已经在治疗武器库中。我们努力评估 NMOSD 治疗的现状。
本综述对利妥昔单抗、依库珠单抗、satralizumab、eculizumab 和 ravulizumab 的最新临床试验和上市后数据进行了实用评估，与较旧的药物进行了对比。我们还回顾了当代的一些问题，如在 SARS-CoV2 感染和怀孕期间的治疗。随着早期和改善的疾病识别、诊断准确性以及更有效、靶向治疗的出现，NMOSD 的发病率和死亡率发生了巨大变化。根据患者的因素和可及性选择维持治疗仍然很复杂。随着 100 多种候选药物在临床试验中，NMOSD 患者现在有了无疾病生存的现实目标。
