Critical Aspects of NMOSD Clinical Care: Brian G. Weinshenker, MD

"We’re now trying to be sure that all patients with a complete diagnosis of AQP4-IgG-NMOSD get on a treatment because the risk of relapse to them is very high and each relapse carries a substantial risk of disability.”

After years of no approved treatment options, the neuromyelitis optica spectrum disorder (NMOSD) community has benefitted from FDA greenlighting therapies such as eculizumab (Soliris; Alexion), inebilizumab (Uplizna; Viela Bio) and satralizumab (Enspryng; Genentech), all in the last 2 years. These therapies, indicated to treat aquaporin-4 autoantibody-positive (AQP4+) patients, have shown the ability to improve the frequency of relapses in this patient population.

Although the presentation of NMOSD is similar to other demyelinating diseases such as multiple sclerosis (MS), relapse recovery is poorer and relapses directly lead to cumulative disability. Because of this, the emphasis on the diagnostic stage and early intervention is even more critical. While the influx of new treatments has drastically altered the landscape, questions still remain regarding treatment optimization, adverse effects, and long-term durability.

For Brian G. Weinshenker, MD, education and recognition are 2 areas of need that need to be focused on more often. Weinshenker, a professor of neurology at Mayo Clinic College of Medicine, told NeurologyLive that there is still much to be learned about the disease, how it progresses, and when it’s appropriate to utilize specific disease-modifying therapies. He also stressed that despite the new options, research efforts should be geared towards developing therapies that have less toxicity and lower infection rates.