Experts have reached a consensus regarding important steps in the management of neuromyelitis optica spectrum disorder (NMOSD), according to a study recently published in Neurology: Neuroimmunology & Neuroinflammation.

“In conclusion, the consensus statements developed in this Delphi process seek to address an unmet need for providing recommendations on the use of eculizumab, inebilizumab, and satralizumab to treat patients with [aquaporin-4 (AQP4)-immunoglobulin G (IgG)]–seropositive NMOSD,” the authors wrote.

This observational study involved a series of questionnaires and interviews following the Delphi method. An initial steering committee of 3 members selected another 21 panel participants from the United States, the United Kingdom, Spain, Brazil, Germany, Japan, Australia, Canada, China, Denmark, India, Israel, Morocco, and South Korea.

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First, all participants completed a targeted literature review of 35 articles on the management of NMOSD, followed by a phase of information gathering, crafting a list of draft statements, and a final voting phase on each statement.

Some of the most important topics the Delphi panel considered were evidence gaps regarding the use of biomarkers, comparative data between the performances of eculizumab, inebilizumab, and satralizumab, and real-world reports.

“Finally, given the importance of patient preferences, as highlighted throughout the statements, more insights into patient preferences for NMOSD treatment would be valuable to better understand the patient perspective and meet patients’ needs,” the authors summarized.

Twenty-five statements became part of the consensus upon agreement of the experts, 7 of which had a unanimous consensus. Of these, 4 referred to the initiation of eculizumab, inebilizumab, or satralizumab, 2 described safety matters, and 1 was about patient populations. None were about monotherapy vs combination therapy, the use of biomarkers and patient-reported outcomes, research gaps, or switching therapy.

The rest of the items obtained at least 80% agreement, except one with 77.8%, which stated that the PREVENT trial demonstrated the efficacy of eculizumab for NMOSD.


Paul F, Marignier R, Palace J, et al. International Delphi consensus on the management of AQP4-IgG+ NMOSD: recommendations for eculizumab, inebilizumab, and satralizumab. Neurol Neuroimmunol Neuroinflamm. Published online May 31, 2023. doi:10.1212/NXI.0000000000200124