Treatment of Neuromyelitis Optica: Review and Recommendations.
Kimbrough DJ., Fujihara K., Jacob A., Lana-Peixoto MA., Leite MI., Levy M., Marignier R., Nakashima I., Palace J., de Seze J., Stuve O., Tenembaum SN., Traboulsee A., Waubant E., Weinshenker BG., Wingerchuk DM., GJCF-CC&BR None.
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.