Treatment of neuromyelitis optica: Review and recommendations
Kimbrough DJ., Fujihara K., Jacob A., Lana-Peixoto MA., Isabel Leite M., Levy M., Marignier R., Nakashima I., Palace J., De Seze J., Stuve O., Tenembaum SN., Traboulsee A., Waubant E., Weinshenker BG., Wingerchuk DM.
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. © 2012 Elsevier B.V.