The landscape of treating neuromyelitis optica spectrum disorder (NMOSD) has drastically changed in recent years. Previously, physicians had limited off-label therapies and little research to guide their treatment decisions. However, advancements in aquaporin-4 (AQP4) research led to the identification of eculizumab, inebilizumab-cdon, and satralizumab-mwge as targeted therapies for NMOSD. These novel options have shifted the clinical care paradigm towards positive outcomes. Additionally, ravulizumab-cwvz is currently being reviewed by the FDA for NMOSD treatment. To discuss the optimal approach to treating patients with NMOSD, NeurologyLive® organized a panel of experts moderated by Brian G. Weinshenker, MD. The panelists emphasized the importance of establishing treatment goals with patients, such as decreasing inflammatory response and preventing relapses. Flavia M. Nelson, MD, highlighted the need for different treatment approaches based on disease stage, including interventions with high-dose steroids or plasma exchange for acute attacks. Aaron E. Miller, MD, stressed the importance of promptly establishing a long-term care plan upon diagnosis to mitigate devastating and unpredictable attacks. Previously, broad-spectrum immunosuppressive medications were used until the development of specific antibody-driven therapies like rituximab and the recent availability of eculizumab, inebilizumab, and satralizumab. The goals of therapy are determined by the severity of the disease and clinical assessments such as MRI scans to evaluate lesion presence and extent. Overall, these advancements have revolutionized the management of NMOSD and provided clinicians with effective treatment options to improve patient outcomes.

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