The early diagnosis and treatment of neuromyelitis optica (NMO) generally improve the outlook for people with this condition. Corticosteroids and immunotherapy are the main treatment options.
NMO, also known as Devic’s disease, is an autoimmune condition that affects about 4,000 people in the United States and close to 250,000 people worldwide. There is no cure for NMO. However, early treatment can improve a person’s outlook, and it may even help reverse damage that occurs during an attack.
In people with NMO, white blood cells and antibodies target the spinal cord, optic nerves, and, sometimes, the brain. Treatment involves addressing current attacks and preventing future ones. Researchers continue to look for new and improved ways to treat NMO.
The following article discusses the current treatment options for NMO, as well as the ongoing research and potential future treatments.
Treatment for NMO consists of two parts: addressing a current attack and preventing future attacks.
During the initial attack, a person’s healthcare team will attempt to get the condition and its symptoms under control. Treatment at this stage often consists of intravenous corticosteroids and plasma exchange (PLEX).
The aim of treating an acute NMO attack is to prevent irreversible and disabling damage to the nervous system, as well as to restore its function.
Plasma exchange (PLEX)
PLEX is an NMO therapy that removes blood from the body and cycles it through a series of filters in a plasma exchange machine to remove the plasma. The machine adds artificial plasma to the remaining blood and returns this mixture to a person’s bloodstream. Doctors typically use PLEX if corticosteroids are ineffective in managing an attack.
During an acute attack, PLEX helps lower the levels of NMO-IgG — an antibody that the body produces naturally — in the blood. NMO-IgG attacks the surface of supportive cells in the brain, spinal cord, and optic nerves. Experts have linked damage to these cells to NMO.
PLEX involves up to
Doctors often prescribe immunotherapy to help prevent future NMO attacks. Immunotherapies suppress the immune system and curb the inflammation driving NMO.
The Food and Drug Administration (FDA) has approved three medications to treat NMO in adults who test positive for anti-aquaporin-4 (AQP4). About 70–80% of people with NMO test positive for AQP4 antibodies.
These medications, which received approval in 2019 and 2020, target a specific part of the immune system responsible for NMO. They include:
- eculizumab (Soliris)
- inebilizumab (Uplizna)
- satralizumab-mwge (Enspryng)
Research suggests that these drugs are safe and effective and that they can
Doctors also prescribe several other immunotherapies for the off-label treatment of NMO. These include:
- azathioprine (Imuran and Azapress, among others)
- mycophenolate mofetil (CellCept)
- rituximab (MabThera, Rixathon, Ruxience, and Truxima)
People usually take azathioprine and mycophenolate mofetil alongside low dosages of corticosteroids.
All immunosuppressive therapies affect the ability of the immune system to fight off infection. However, the benefits of these medications generally outweigh the potential risks.
People using immunosuppressive therapies can reduce their risk of getting an infection by:
- washing their hands regularly and thoroughly with soap and water
- staying away from people who have an infectious disease, such as the flu
- consulting a doctor at the first signs of a cold or fever
Immunotherapies can cause side effects. These vary among the different drugs, but common side effects include:
- pain or swelling of the nose or throat
- back pain
- joint pain
- common cold
- throat irritation
- flu-like symptoms, such as fever, headaches, and fatigue
- a cough
- a sore throat
- body aches
These medications can sometimes cause more severe side effects, such as a serious infusion reaction or allergic reaction.
Clinical trials are studies that seek to determine the effectiveness and safety of new medications and therapies. These studies play an important role in finding effective, safe treatment options for conditions such as NMO.
A person should talk with their doctor if they are interested in participating in a clinical trial. A doctor can help determine whether a person is eligible for a trial or whether they should avoid clinical trials due to specific health concerns.
In some cases, a doctor may know of ongoing studies in the area. Participating in a local study can reduce transportation costs.
People can find ongoing studies that may be recruiting participants at ClinicalTrials.gov. A person can search for neuromyelitis optica and then narrow their search to a specific area of the country.
Before signing up for a trial, a person should talk with their doctor about the potential benefits and downsides. The International Society For Stem Cell Research recommends that individuals ask the following questions to determine whether they will get want they want out of the trial:
- What is the purpose of the trial?
- How much will it cost, or what costs can a participant expect?
- How safe is the trial?
- What are the eligibility criteria?
- What follow-up care is available?
- What are the researchers expecting from participants?
- Will participating in the trial affect other healthcare or treatment options?
There is currently no cure for NMO. Instead, treatment focuses on resolving an attack and preventing future attacks.
Maintaining remission is critical to a person’s overall treatment success. A 2019 study concluded that immunosuppressants could help achieve ongoing remission. The authors noted that without treatment, about 1 in 3 people with NMO will die within 5 years of their first attack, and 50% will be blind and require a wheelchair.
In another 2019 study, researchers found that early diagnosis and treatment helped improve treatment outcomes and recovery in people with more severe initial attacks on their optical nerve or spinal cord.
A person should follow all the treatment recommendations from their doctor to help prevent future attacks and maximize the chance of remission. They should talk with their doctor if they experience side effects or other issues when taking their medication.
People with NMO require both immediate treatment for attacks and ongoing care to prevent future attacks. Treatment typically involves intravenous corticosteroids, PLEX, and immunotherapy.
There is currently no cure for NMO, but researchers are continuing to look for new and improved ways to treat and prevent NMO.
People who are interested in joining a clinical trial should discuss their eligibility with their doctor and consider other factors, such as costs and what they hope to get out of the trial.