Serostatus and the delay to plasma exchange treatment are 2 prognostic factors for neuromyelitis optica spectrum disorder (NMOSD), according to a new study published in the Journal of Neuroinflammation.

The authors of the study suggest that a first attack suggestive of NMOSD should be treated using an aggressive anti-inflammatory approach with plasma exchange and corticosteroids. 

If NMOSD attacks are not treated promptly, they can lead to disability. It is, therefore, very important to identify and treat these attacks as soon as possible.


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To identify predictors of outcome following a first NMOSD attack and determine the best treatment strategy, a team of researchers led by Nicolas Collongues, MD, PhD, from the Department of Neurology at Strasbourg University Hospital in France conducted a retrospective cohort study using data from the French national NMOSD registry, which is part of the French multiple sclerosis observatory.

The researchers analyzed 211 attacks, which occurred in 183 patients. Of these patients, 104 had anti-aquaporin 4 (AQP4) antibodies, 60 had anti-myelin oligodendrocyte glycoprotein (MOG) antibodies, and 19 did not have either antibody in their serum.

Of the attacks, 196 were treated with corticosteroids, 72 were treated with plasma exchange, and 6 were treated with intravenous immunoglobulins.

In 40 attacks, treatment led to complete recovery at 6 months, while in 134, the response to treatment was “good.” In 50 of the attacks, treatment did not lead to any improvements in the Expanded Disability Status Scale (EDSS) score.

The researchers found that having anti-MOG antibodies and a short delay before treatment with plasma exchange were “significantly and independently associated with better recovery and treatment response.”

They therefore suggest that attacks should be managed early with plasma exchange plus corticosteroids, and said patients with anti-MOG antibodies in their serum should be classified as having “MOG-associated disease.” 

Reference

Demuth S, Guillaume M, Bourre B, et al; NOMADMUS Study Group. Treatment regimens for neuromyelitis optica spectrum disorder attacks: a retrospective cohort study. J Neuroinflammation. 2022;19(1):62. doi:10.1186/s12974-022-02420-2