NMOSD Prognosis
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The use of therapies classified as high-efficacy dramatically reduced the number of clinical and radiological events in patients with neuromyelitis optica spectrum disorder (NMOSD) compared to traditional therapies, according to a study published in the Journal of Neurology.

Compared to traditional treatments, high-efficacy therapies reduced the rate of disease advancement observed on MRI by 62.4%, relapses by 99.8%, and hospitalizations by 99.3% for the entire cohort of patients with NMOSD (n=189). When investigating the subset of patients positive for aquaporin-4 IgG (AQP4+; n=161), the event rate of relapses and hospitalizations dropped by 99.5% and 98.4%, respectively.

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The odds of MRI advancement in the spinal cord were 655.7-fold higher (P <.0001) in the AQP4+ group during traditional treatment when compared to high-efficacy treatment. No difference was observed in the odds of advancement involving the brain, however (P =.14).

The odds of experiencing multifocal events on MRI were also significantly reduced for the entire cohort (97.5%; P <.0001) and the AQP4+ cohort (97.0%; P =.0004) when receiving high-efficacy treatment compared to traditional treatment.

“This retrospective study provides evidence of the value of high-efficacy therapy use in a large cohort of individuals with confirmed NMOSD and represents a meaningful step towards answering an important question involving the best treatment approaches for care,” the authors wrote.

During the study, treatments categorized as high-efficacy included eculizumab, inebilizumab, satralizumab, rituximab, ocrelizumab, tocilizumab, and sarilumab, while traditional agents included azathioprine, methotrexate, mycophenolate mofetil, intravenous immunoglobulin (IVIg), cyclophosphamide, mycophenolic acid, and glucocorticoids.

A total of 189 patients with NMOSD were included in the study, with 161 being AQP4+ seropositive. In the full cohort, 92 patients received only high-efficacy treatments, 33 received traditional treatments only, and the remaining 64 received both. No major differences were between the treatment groups in terms of the percentage of females, AQP4+, and nonWhite patients. The ages at onset and disease duration were also not different between the treatment groups. 


Moog TM, Smith AD, Burgess KW, et al. High-efficacy therapies reduce clinical and radiological events more effectively than traditional treatments in neuromyelitis optica spectrum disorder. J Neurol. Published online April 13, 2023. doi:10.1007/s00415-023-11710-5