Dementia and Alzheimer Disease

Epilepsy

Migraine

Headache and Migraine

MS Advanced Practice Providers

Multiple Sclerosis

NMOSD

MS and Demyelinating Disorders

Parkinson Disease

Movement Disorders

Ataxia

Chronic Inflammatory Demyelinating Polyneuropathy

Muscular Dystrophy

Neuromuscular

Insomnia

Narcolepsy

Sleep Disorders

Stroke

News

Media

All Videos

Medical World News

Podcasts

Weekly Recap

Cure Connections

Insights

Special Report

NeurologyLive Peer Exchange

Medcast

Peers & Perspectives

Roundtable Discussions

Conferences

Conference Coverage

Conference Listing

CME/CE

Partners

Publications

NeurologyLive

Bridging the Gaps

International Journal of MS Care

Resources

Expert Authors

FDA News

Features

Fellows' Corner

Future Leaders in Neurology

Giants of Multiple Sclerosis

Interactive Tools

Live Events

Neurology Resources

Virtual Events

Subscribe

Articles

Catch up on any of the neurology news headlines you may have missed over the course of February 2025, compiled all into one place by the NeurologyLive® team.

FDA Action Update, February 2025: Approvals, Designations, and Acceptances

Videos

The instructor in the department of radiology at Weill Cornell Medicine discussed how structural and functional brain connectomes can potentially improve predictions of MS progression and treatment response. [WATCH TIME: 4 minutes]

Using Brain Connectomes to Predict and Influence Multiple Sclerosis Progression: Ceren Tozlu, PhD

Test your neurology knowledge with NeurologyLive®'s weekly quiz series, featuring questions on a variety of clinical and historical neurology topics. This week's topic is on Parkinson disease.

NeurologyLive® Brain Games: March 9, 2025

A post-hoc analysis of patients from the CHAMPION-NMOSD trial revealed that the majority received their initial meningococcal vaccination within 6-months of their last rituximab dose. 

Pretreatment Meningoccal Vaccination Rates High Among Patients With NMOSD Transitioning From Rituximab to Ravulizumab

The child neurologist and neuroimmunologist at Nationwide Children’s Hospital provided clinical insight on the complexities of treating pediatric MOGAD, including treatment options, decision-making factors, and emerging therapies. [WATCH TIME: 4 minutes]

Treatment Decisions and Personalization for Pediatric MOGAD: Kelsey Poisson, MD

Marco Meglio, Assistant Managing Editor for 

, has been with the team since October 2019. Follow him on Twitter 

Mind Moments®, a podcast from NeurologyLive®, brings you an exclusive interview with Sonal Bhatia, MD, FACNS. [LISTEN TIME: 24 minutes]

Episode 136: Raising Epilepsy Awareness for Purple Day

The assistant professor in the neurology department at the University of Utah in Salt Lake City discussed advancing personalized medicine for patients with neuromyelitis optica spectrum disorder, a rare disorder of the central nervous system. [WATCH TIME: 4 minutes]

Furthering the Conversation of Treatment Personalization in NMOSD: Tammy Smith, MD, PhD

Attending Physician, Neuromuscular/General Neurology & Electromyography; Neuromuscular Education Director and Neuromuscular Section Head, Children’s Hospital of Philadelphia

The pediatric neurologist at Children’s Hospital of Philadelphia gave perspective on some of the main issues the clinical community is figuring out with gene therapies and their integration to clinical practice. [WATCH TIME: 3 minutes]

Clinically Relevant Challenges and Roadblocks of Gene Therapies for Muscular Dystrophies: John Brandsema, MD

NeurologyLive is your direct connection to the latest neurology news and interviews with expert neurologists in multimedia formats.

About Us

Advisory Board

Editorial

Contact Us

Advertise

Contact MJH LS

Do Not Sell My Information

Terms and Conditions

Privacy

NeurologyLive – Clinical Neurology News and Neurology Expert Insights

Facebook

LinkedIN

YouTube

Spotlight

ACTRIMS 2025

ISC 2025

Clinical Focus

Dementia/Alzheimer

Headache/Migraine

Video Series

News Network

1.125rem

Clinical

 MS Disease Spotlight page offers specific updates and coverage on the latest expert conversations and data readouts related to the treatment and management of patients with multiple sclerosis and demyelinating disorders.

A recent study reported that the presence of oligoclonal bands in cerebrospinal fluid of patients with myelin oligodendrocyte glycoprotein antibody-associated disease may be associated with a higher risk of relapse.

Oligoclonal Bands in Cerebrospinal Fluid May Signal Higher Relapse Risk in MOGAD

A newly developed advanced fMRI-based classification model demonstrated efficacy in distinguishing multiple sclerosis from neuromyelitis optica spectrum disorder, potentially having the ability to improve diagnostic accuracy.

New Functional MRI Model Shows High Accuracy in Differentiating Between MS and NMOSD

Cerebrospinal fluid lipid profiling revealed potential biomarkers for distinguishing NMOSD from MS and tracking disease activity, offering new insights into neuroinflammatory disease monitoring. 

Cerebrospinal Fluid Lipids Shows Promise as Biomarkers for Differentiating NMOSD and MS

A recent study reported significantly elevated cerebrospinal fluid inflammatory markers in pediatric myelin oligodendrocyte glycoprotein antibody-associated disease during acute phases.

Study Identifies Key Inflammatory Markers in Pediatric MOGAD, Suggesting New Therapeutic Targets

Kelsey Poisson on pediatric MOGAD

"Most clinicians would not start maintenance treatment on a child with a first attack of MOGAD, unless there are certain high-risk factors for relapse or if the attack was severe."

Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is an autoimmune demyelinating disorder associated with antibodies against MOG that impacts both children and adults. Typically, the most common manifestations of MOGAD are acute optic neuritis (ON) with or without transverse myelitis (TM), and in children, acute disseminated encephalomyelitis (ADEM). MOGAD is considered mainly a monophasic disease; however, some experience relapses that differ from the phenotypic manifestations at the first event.

To date, there are no FDA-approved treatments for MOGAD specifically, although there are several emerging studies testing potentially efficacious options. These include the phase 3 METEOROID study testing satralizumab (Enspryng; Genentech), an FDA-approved treatment for neuromyelitis optica spectrum disorder (NMOSD), as well as another phase 3 study of rozanolixizumab (Rystiggo; UCB), a marketed therapy for adults with anti-acetylcholine receptor (AChR) or anti-muscle-specific tyrosine kinase (MuSK) antibody positive myasthenia gravis.

Treatment for pediatric MOGAD involves a combination of acute treatments and maintenance therapies, tailored to the severity of the disease, the frequency of relapses, and individual patient factors. Recently, MOGAD expert Kelsey Poisson, MD, a child neurologist and neuroimmunologist at Nationwide Children’s Hospital, sat down to discuss the treatment course for this age population. In the discussion, she emphasized the need for more research to determine which patients require maintenance therapy versus just acute treatment.

Poisson, who also serves as an assistant professor at clinical pediatrics and neurology at The Ohio State University College of Medicine, highlighted the importance of individualized care, factoring the child’s preferences, age, and ability to tolerate treatments. She also spoke on some of the emerging therapies being explored, such as mycophenolate, rituximab, and IL-6 inhibitors. Lastly, she stressed the challenges of when to initiate maintenance therapy, as less than 50% of children experience relapses.

SAP Partners

Choosing right treatments for patients with NMOSD

Tammy Smith on NMOSD treatment selection

"Fatigue that is not minor to them... if we overlook that our patients are too fatigued to take care of their kids, we're missing a huge opportunity to take care of our patients."

More than a decade ago, the discovery of aquaporin-4 (AQP4) led to the rapid drug development for patients with neuromyelitis optica spectrum disorder (NMOSD), a rare, demyelinating disorder of the central nervous system. The first approved therapy, eculizumab (Soliris; Alexion) came in 2019, followed by others, including satralizumab (Enspryng; Genentech) and inebilizumab (Uplizna; Amgen). More recently, in 2024, the FDA approved ravulizumab (Ultomiris; Alexion), another complement C5 inhibitor, as the latest treatment for those living with the condition.

In addition to these monoclonal antibodies, patients can also turn to other treatments such as rituximab (Rituxan) and immunosuppressives, such as azathioprine, mycophenolate, methotrexate, cyclophosphamide, and tocilizumab. Intravenous immunoglobulins, also known as antibodies, have also been shown to decrease the relapse rate of neuromyelitis optica. As the treatment landscape for NMOSD has expanded, the conversations around personalization and improving therapy selection have gained more attention.

, an assistant professor in the neurology department at the University of Utah in Salt Lake City, recently sat down with 

® to discuss the topic of precision medicine for patients with NMOSD. While current treatments are based on biomarkers like AQP4 for seropositive patients, she stressed the need for further research into biomarkers for seronegative patients and the variability within AQP4-positive patients. In addition, Smith emphasized the importance of considering quality of life factors, such as fatigue, which can significantly affect patients despite treatment progress.

The director of the MS and Demyelinating Disease Center at Texas Tech University Health Sciences Center talked about early diagnosis, timely treatment, and minimizing therapy transition gaps to prevent severe disability in patients with NMOSD. 

The Urgency of Early Diagnosis and Treatment in Neuromyelitis Optica Spectrum Disorder: Mirla Avila, MD

"Diagnosing at an early stage and starting one of the FDA-approved medications really makes a big difference in how the patient [with NMOSD] is going to do later on."

Neuromyelitis optica spectrum disorder (NMOSD) is a rare yet severe neurological condition that primarily affects the optic nerves and spinal cord. Characterized by acute relapses, the disease can lead to significant and often permanent disability.

The condition is frequently misdiagnosed as multiple sclerosis (MS) because of symptom overlap, which can result in inappropriate treatment with MS-specific therapies that may worsen NMOSD symptoms. As a result, timely and accurate diagnosis may be critical to initiating appropriate treatments that target the inflammatory processes specific to NMOSD. Recent advances, including biologic therapies like eculizumab (Soliris; Alexion), have improved clinicians' ability to manage the disease by preventing relapses and minimizing long-term damage.

The importance of appropriate NMOSD treatment and disease management was a focal point at the 

2025 Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS) Forum

, held February 27 to March 1, in West Palm Beach, Florida.

 A continuing education (CE) program at the event, chaired by Shamik Bhattacharyya, MD, featured expert insights from Dean M. Wingerchuk, MD, FRCP(C), and 

. The program covered NMOSD pathogenesis, mechanisms of action of current therapies, and recent updates in clinical trial data. By the end of the session, participants were expected to understand NMOSD’s impact on patients’ daily lives, evaluate clinical trial data on emerging therapies, and implement evidence-based treatment modifications based on individual patient response.

At the meeting, Avila, who serves as the director of the Multiple Sclerosis and Demyelinating Disease Center at Texas Tech University Health Sciences Center, spoke with 

 about the aggressive nature of NMOSD relapses. She emphasized that without prompt treatment, these relapses can lead to irreversible disability. Avila highlighted the importance of early diagnosis, the risks associated with misdiagnosis, and the necessity of initiating FDA-approved therapies without delay. She also underscored the critical role of clinician education in recognizing atypical presentations of NMOSD, ensuring patients receive timely and appropriate care.

Click here for coverage of 2025 ACTRIMS Forum.

REFERENCES
1. Jarius S, Paul F, Aktas O, et al. Neuromyelitis optica spectrum disorders: update on diagnosis, pathophysiology, and treatment. J Neurol. 2023;270(9):4673-4694. doi:10.1007/s00415-023-11910-z
2. Mealy MA, Wingerchuk DM, Greenberg BM, Levy M, Longbrake EE. Treatment strategies and emerging therapies in neuromyelitis optica spectrum disorder. Front Neurol. 2023;14:10356911. doi:10.3389/fneur.2023.10356911
3. Bhattacharyya S, Wingerchuk DM, Avila M. A New Era in NMOSD Treatment: Optimizing Therapeutic Transitions and Reducing Patient Burden. Presented at ACTRIMS Forum 2025; February 27 to March 1; West Palm Beach, Florida. SS5.

The director of the MS and Demyelinating Disease Center at Texas Tech University Health Sciences Center talked about early diagnosis, timely treatment, and minimizing therapy transition gaps to prevent severe disability in patients with NMOSD. [WATCH TIME: 4 minutes]

The founder and executive director of the Sumaira Foundation talked about how the landscape of NMOSD treatment has drastically improved with FDA-approved therapies, while noting that accessibility and awareness remain significant challenges. 

A Patient’s Perspective on Progress and Challenges in NMOSD Treatment Advances: Sumaira Ahmed

"I don’t think NMOSD is this deadly diagnosis anymore, and that’s largely [because of] all of the advancements we’ve had in treatments—and I would say diagnostics as well."

Recent advancements in the treatment of neuromyelitis optica spectrum disorder (NMOSD) have significantly transformed patient experiences, particularly in terms of clinical outcomes and quality of life. The introduction of targeted therapies, such as inebilizumab (Uplizna; Amgen), has been pivotal for patients. Clinical studies have demonstrated that following 3 years of inebilizumab treatment, 89% of patients with initially abnormal quality of life scores reported improvements. Additionally, among the 39% of patients with NMOSD who experienced abnormal pain levels at baseline, 78% reported reductions in pain intensity.

However, despite these therapeutic advancements, challenges remain in ensuring optimal patient care. Research has indicated that even a single NMOSD relapse can lead to increased disability and diminished health-related quality of life, emphasizing the critical need for effective relapse prevention strategies.

 Additionally, chronic NMOSD-associated pain continues to impact patients, with pain severity being a significant predictor of reduced quality of life.

 Addressing these ongoing issues may require a comprehensive management approach that not only prevents relapses but also alleviates persistent symptoms to enhance overall patient well-being.

, held February 27 to March 1, in West Palm Beach, Florida, 

, founder and executive director of the Sumaira Foundation, underscored these challenges during an interview with 

. Reflecting on the evolution of NMOSD treatment, Ahmed highlighted the dramatic shift from a dire prognosis with limited off-label options to the availability of four FDA-approved therapies. Although these treatments have significantly improved patient outcomes, she emphasized the continued barriers to accessibility. Furthermore, Ahmed pointed out that some clinicians still favor outdated off-label therapies, reinforcing the need for ongoing education and advocacy to ensure patients receive the most effective and evidence-based treatment options.

REFERENCES
1. Cree BAC, Kim HJ, Weinshenker BG, et al. Safety and efficacy of inebilizumab for the treatment of neuromyelitis optica spectrum disorder: end-of-study results from the open-label period of the N-MOmentum trial. Lancet Neurol. 2024;23(6):588-602. doi:10.1016/S1474-4422(24)00077-2
2. Berthele A, Levy M, Wingerchuk DM, et al. A single relapse induces worsening of disability and health-related quality of life in patients with neuromyelitis optica spectrum disorder. Front Neurol. 2023;14:1099376. Published 2023 Apr 11. doi:10.3389/fneur.2023.1099376
3. Ayzenberg I, Richter D, Henke E, et al. Pain, Depression, and Quality of Life in Neuromyelitis Optica Spectrum Disorder: A Cross-Sectional Study of 166 AQP4 Antibody-Seropositive Patients. Neurol Neuroimmunol Neuroinflamm. 2021;8(3):e985. Published 2021 Apr 20. doi:10.1212/NXI.0000000000000985

The founder and executive director of the Sumaira Foundation talked about how the landscape of NMOSD treatment has drastically improved with FDA-approved therapies, while noting that accessibility and awareness remain significant challenges. [WATCH TIME: 4 minutes]

The assistant professor of medicine at the University of Toronto talked about emerging research on how prodromal symptoms may aid in the early identification of multiple sclerosis and neuromyelitis optica spectrum disorder. 

Recognizing and Investigating the Prodromal Phase in MS and NMOSD: Dalia Rotstein, MD, MPH

"Recognizing prodromal symptoms in an individual, especially a younger adult, could inspire further investigations into the possibility of demyelinating disease."

Prodromes in central nervous system (CNS) demyelinating diseases, such as multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD), refer to early, nonspecific symptoms that precede more defined clinical manifestations. Recent evidence suggests that recognizing these early symptoms like fatigue, musculoskeletal pain, and sensory disturbances could provide valuable opportunities for early diagnosis and intervention. For instance, studies have shown that the detection of aquaporin-4 antibodies during the preclinical phase of NMOSD may help guide timely therapeutic strategies, potentially improving patient outcomes.

 Identifying these prodromal phases may be crucial for facilitating earlier interventions that can alter the disease's progression.

This concept of prodromes was explored in greater detail during the "Connecting to Diseases Beyond MS" session at the 

, held February 27 to March 1, in West Palm Beach, Florida. Chaired by Douglas Sato, MD, and Jodie Burton, MD, the session included presentations on genetic risk, transcriptomic changes, and immunopathology. 

, discussed the emerging role of prodromes in central nervous system (CNS) demyelinating diseases while other speakers, including Matthew Lincoln, MD, DPhil, and Kevin O’Connor, PhD, highlighted shared genetic risk loci, transcriptomic differences, and the distinct immunopathology of MOG antibody-associated disease (MOGAD).

Together, these presentations underscored the importance of cross-disease comparisons to enhance our understanding of demyelinating conditions. At the Forum, Rotstein, an assistant professor of medicine at the University of Toronto, also sat down for an interview with 

 to discuss the latest evidence suggesting that prodromal symptoms could aid in early identification of CNS demyelinating diseases. She elaborated on how recognizing these early features might influence clinical decision-making and disease-modifying treatment strategies, while also addressing the challenges in distinguishing these symptoms from those of other neurological or systemic conditions.

REFERENCES
1. Fadda G, Flanagan EP, Cacciaguerra L, et al. Myelitis features and outcomes in CNS demyelinating disorders: Comparison between multiple sclerosis, MOGAD, and AQP4-IgG-positive NMOSD. Front Neurol. 2022;13:1011579. Published 2022 Nov 7. doi:10.3389/fneur.2022.1011579
2. Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS). Program Agenda. Accessed February 27, 2025. https://forum.actrims.org/program
3. Zandee S. Linking MS Immune Cell Protein Signature With Clinical Progression. Presented at ACTRIMS Forum 2025; February 27 to March 1; West Palm Beach, Florida. S5.1

The assistant professor of medicine at the University of Toronto talked about emerging research on how prodromal symptoms may aid in the early identification of multiple sclerosis and neuromyelitis optica spectrum disorder. [WATCH TIME: 6 minutes]

"Creating a culture in your clinic where you ask about broader quality-of-life issues is fundamental for truly comprehensive care."

In neuromyelitis optica spectrum disorder (NMOSD), an inflammatory disorder of the central nervous system, relapse prevention has always been the main goal, as recurrent attacks are the key driver of neurological impairment. The most common approach to acute relapse management has been immediate initiation of high-dose corticosteroids, with a slow taper to ameliorate neurological impairment. Unfortunately, for a number of patients living with the disease, corticosteroids are not sufficient, and another immunotherapy is often needed.

The discovery of aquaporin-4 (AQP4), an antibody directly linked to NMOSD, has opened the door for several new treatments in recent years, each with varying mechanisms of action. While these drugs have significantly better efficacy on relapses, there are still several other notable symptoms that impact patients’ quality of life, including visual disturbances, spinal cord symptoms, fatigue and pain, and other neurological issues such as muscle spasms, stiffness, or tremors. A truly comprehensive and effective treatment strategy will address not only relapses, but the rest of the disease, says 

Smith, an assistant professor in the neurology department at the University of Utah in Salt Lake City, recently sat down with 

® to discuss best strategies in maintaining a high quality of life for patients with NMOSD. She highlighted the need for clinicians to discuss often-overlooked issues such as fatigue, mood disorders, chronic pain, and sexual dysfunction with patients to ensure holistic care. Additionally, she emphasized the neurologist’s role in reinforcing healthy lifestyle habits, such as smoking cessation, regular exercise, and a healthy diet, while also encouraging routine screenings and collaboration with primary care providers for comprehensive care.

The assistant professor in the neurology department at the University of Utah in Salt Lake City discussed the importance of addressing broader quality-of-life measures in patients with NMOSD beyond just preventing relapses. [WATCH TIME: 3 minutes]

Managing NMOSD Disease Progression Through Healthy Habits and Holistic Care: Tammy Smith, MD, PhD

"Relapses in NMOSD are associated with such significant disability that we can't risk using less effective treatments in this population."

Neuromyelitis optica spectrum disorder (NMOSD) is a chronic, severe, autoimmune demyelinating disease of the central nervous system that primarily affects the spinal cord and optic nerves. NMOSD is considered a rare disease with a global incidence of approximately 0.039-0.73/100,000 and is more prevalent in young and middle-aged females, with a male-to-female incidence ratio of about 1:9. Although NMOSD has a low incidence, it is linked to high relapse rates and disability, leading to worsening neurological function, reduced quality of life, and a significant burden on individuals and society.

Before the availability of disease-modifying therapies (DMT)—which first came in 2019—the treatment for NMOSD focused on acute symptom management, typically using corticosteroids or plasmapheresis for relapses. In 2019, the field broke through with its first approved treatment for aquaporin-4-antibody-positive forms of the disease, giving greenlight to eculizumab (Soliris; Alexion). Shortly after, the FDA approved inebilizumab (Uplizna; Horizon) and satralizumab (Enspryng), allowing for more treatment flexibility with differing mechanisms of action. In 2024, the agency approved ravulizumab (Ultomiris; Alexion), a complement C5 inhibitor, as the latest treatment for those with the disease.

®, NMOSD expert Tammy Smith, MD, PhD, provided a comprehensive overview of FDA-approved and off-label treatments for NMOSD, categorizing them based on their mechanisms of action. Smith, an assistant professor in the neurology department at the University of Utah in Salt Lake City, highlighted the newer therapies, including anti-CD19 agents, IL-6 receptor inhibitors, and complement inhibitors, while contrasting these with older treatments like rituximab and azathioprine. Above all, she stressed the need to tailor treatments based on patient preferences, logistical considerations, and safety profiles, noting the importance of vaccination protocols, dosing intervals, and administration routes for the different drug classes.

The assistant professor in the neurology department at the University of Utah in Salt Lake City provided a clinical overview of the new and old therapies for NMOSD, and how clinicians should go about choosing for their patients. [WATCH TIME: 6 minutes]

Understanding the Process Behind Treatment Selection in NMOSD: Tammy Smith, MD, PhD

The associate professor of neurology at Harvard Medical School talked about reconsidering therapy switches for NMOSD, incorporating safety failures like recurrent infections, and prioritizing real-world studies to validate findings. 

Rethinking Treatment Strategies in NMOSD Based on Safety Failures and Emerging Therapies: Shamik Bhattacharyya, MD

"Our concept of what constitutes failure might need to evolve into a combination of efficacy failure and safety failure. That could be a more comprehensive way to think about it."

There are currently 4 FDA-approved therapies for aquaporin-4-antibody seropositive neuromyelitis optica spectrum disorder (NMOSD): satralizumab (Enspryng; Genentech), eculizumab (Soliris; Alexion), ravulizumab (Ultomiris; Alexion), and inebilizumab (Uplizna; Amgen). Additionally, rituximab, mycophenolate mofetil (MMF), and azathioprine (AZA) remain commonly used treatments. A recent study presented at the 

2024 European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) Congress

, September 18-20, in Copenhagen, Denmark, evaluated the efficacy and safety of these therapies in 107 patients with NMOSD, predominantly women (82.2%), with a median follow-up of 9.8 years. Among 280 relapses analyzed, 65.3% required hospitalization, and 83.5% were associated with new MRI T2 lesions.

The study reported varying failure rates, defined as at least 1 relapse on treatment, with rituximab at 40%, MMF at 59%, and AZA at 75%. Notably, no relapses occurred with satralizumab, while eculizumab and inebilizumab each reported one relapse during early treatment. Non-relapse hospitalizations were common, with infections accounting for 55.7% of cases, predominantly in patients on rituximab (57.9%). Overall, these findings highlighted the need for careful consideration of both efficacy and safety when selecting NMOSD therapies.

, a neurologist at Brigham and Women’s Hospital, expanded on these findings in an interview with 

. He discussed the critical balance clinicians must strike between efficacy and safety when deciding to switch NMOSD therapies, particularly in light of recurrent infections and treatment-related failures. Bhattacharyya emphasized the importance of robust observational studies to better capture real-world outcomes across diverse patient populations, which often differ from clinical trial cohorts. Additionally, he highlighted how evolving diagnostic criteria for multiple sclerosis could improve early diagnosis and prompt treatment initiation, ultimately optimizing patient outcomes.

Click here for more coverage of ECTRIMS 2024.

REFERENCES
1. Bilodeau PA, Narasimhan S, Pua DK, et al. Comparative Effectiveness and Safety of Disease-modifying Treatments (DMTs) in a Real-World Neuromyelitis Optica Spectrum Disorder Cohort (NMOSD). Presented at: 2024 ECTRIMS; September 18-20; Copenhagen, Denmark. Abstract P022.

The associate professor of neurology at Harvard Medical School talked about reconsidering therapy switches for NMOSD, incorporating safety failures like recurrent infections, and prioritizing real-world studies to validate findings. [WATCH TIME: 5 minutes]

Shamik Bhattacharyya, MD, discussed a study presented at ECTRIMS 2024 that compared the effectiveness and safety profiles of FDA-approved NMOSD therapies with other commonly used treatments.

Comparative Analysis Insights on Neuromyelitis Optica Spectrum Disorder Treatments: Shamik Bhattacharyya, MD

"We are very often as a field focused on relapses, and perhaps not enough on infection hospitalizations or other serious complications of therapy."

Currently, there are 4 FDA-approved treatments for aquaporin-4-antibody seropositive neuromyelitis optica spectrum disorder (NMOSD): satralizumab (Enspryng; Genentech), eculizumab (Soliris; Alexion), ravulizumab (Ultomiris; Alexion), and inebilizumab (Uplizna; Amgen). Besides these therapies, rituximab (RTX), mycophenolate mofetil (MMF) and azathioprine (AZA) are also commonly used to treat the disease. At the 

, September 18-20, in Copenhagen, Denmark, a new study presented assessed the efficacy and safety of both off- and on-label therapies in the treatment of patients with NMOSD.

In this analysis of patients with NMOSD (n = 107), investigators collected data from the Mass General Brigham system (mean age at diagnosis, 45.3 years [SD, 15.9]; AQP4 positive, 93.4%, women, 82.2%; White 63.6%) as well as defined relapses as new signs and symptoms consistent with a core NMOSD phenotype. Authors also included all non-relapse hospitalizations and noted that the median follow-up was 9.8 years (IQR 8.1). Among the total 280 relapses analyzed by researchers, 65.3% of them were reported as requiring hospitalization and 83.5% of the relapses with available MRI had a new T2 lesion.

Conducted senior author Shamik Bhattacharyya, MD, and colleagues, 85 patients were given rituximab, compared with 27 patients for MMF, 12 patients for AZA, 4 patients for satralizumab, 5 patients for inebilizumab, and 9 patients for eculizumab. The median treatment duration was 6.5 years (IQR 7.5) for MMF, 5.8 years (IQR 6.4) for rituximab, 1.05 years (IQR 3.69) for AZA, 2.1 years (IQR 2.74) for eculizumab, 3.0 years (IQR 0.13) for inebilizumab and 1.2 years (IQR 2.3) for satralizumab. The failure rate, which was defined as at least 1 relapse on treatment, was reported by investigators as 40% for rituximab, 59% for MMF and 75% for AZA.

In the analysis, the most common treatments at relapse were rituximab (30.6%), MMF (23.2%) and AZA (11.0%). Researchers also reported no relapses observed with patients on satralizumab, 1 relapse reported on eculizumab 1 week after starting treatment, and 1 relapse reported on inebilizumab prior to completing the initial load. In 183 non-relapse hospitalizations recorded, 55.7% were because of infections and 57.9% were reported while on rituximab treatment, compared with 23.2% for MMF and less than 1% for satralizumab, inebilizumab, and eculizumab.

During the Congress, Bhattacharyya, a neurologist at Brigham and Women's Hospital, sat down with 

 in an interview to discuss how relapse rates in NMOSD differed between rituximab and the newer FDA-approved therapies. He also talked about the factors that may contribute to the 30% failure rate of rituximab in preventing NMOSD relapses. Furthermore, Bhattacharyya, who also serves as an associate professor of neurology at Harvard Medical School, spoke about the barriers that might exist for patients who would switch from rituximab to newer NMOSD therapies.

The associate professor of neurology at Harvard Medical School discussed a study presented at ECTRIMS 2024 that compared the effectiveness and safety profiles of FDA-approved NMOSD therapies with other commonly used treatments. [WATCH TIME: 4 minutes]

MOGAD diagnosis pearls

Over the last 2 decades, the understanding of inflammatory demyelinating disorders of the central nervous system has radically changed with the identification of specific autoantibody-associated conditions distinct from multiple sclerosis (MS), namely aquaporin-4-IgG-positive neuromyelitis optica spectrum disorder (NMOSD) and myelin oligodendrocyte glycoprotein (MOG)-IgG-associated disease. In the most recently published diagnostic criteria of MOGAD, the identification of MOG-IgG was considered a core criterion, marking a major step in improving care and diagnosis rates.

, and others, noted that MOGAD is typically associated with acute disseminated encephalomyelitis, optic neuritis, or transverse myelitis, and is less commonly associated with cerebral cortical encephalitis, brainstem presentations, or cerebellar presentations. In collaboration with the 

Siegel Rare Neuroimmune Association (SRNA)

® gathered Bennett and autoimmune expert 

In this episode, a pair of neuroimmune experts discussed some of the emerging research for patients with MOGAD, highlighting the need for immunological markers, remodeling therapies, and enhancements to diagnostic criteria. [WATCH TIME: 5 minutes]

NMOSD

Latest News