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Mult Scler Relat Disord. 2012 Oct;1(4):180-187.

Treatment of Neuromyelitis Optica: Review and Recommendations.

Author information

1
Johns Hopkins University, Baltimore MD, USA.
2
Tohoku University School of Medicine, Sendai, Japan.
3
The Walton Centre for Neurology and Neurosurgery, Liverpool, United Kingdom.
4
Medical School of the Federal University of Minas Gerais, Belo Horizonte MG, Brazil.
5
John Radcliffe Hospital, Oxford University, Oxford, UK.
6
Service de Neurologie A, Université de Lyon, Lyon, France.
7
University Hospital of Strasbourg, Strasbourg, France.
8
University of Texas Southwestern, Dallas, TX, USA.
9
National Pediatric Hospital Dr. Juan P. Garrahan, Buenos Aires, Argentina.
10
University of British Columbia, Vancouver BC, Canada.
11
University of California, San Francisco, San Francisco CA, USA.
12
Mayo Clinic, Rochester MN, USA.
13
Mayo Clinic, Scottsdale AZ, USA.

Abstract

Neuromyelitis optica (NMO) is an autoimmune demyelinating disease preferentially targeting the optic nerves and spinal cord. Once regarded as a variant of multiple sclerosis (MS), NMO is now recognized to be a different disease with unique pathology and immunopathogenesis that does not respond to traditional MS immunomodulators such as interferons. Preventive therapy in NMO has focused on a range of immunosuppressive medications, none of which have been validated in a rigorous randomized trial. However, multiple retrospective and a few recent prospective studies have provided evidence for the use of six medications for the prevention of NMO exacerbations: azathioprine, rituximab, mycophenolate mofetil, prednisone, methotrexate and mitoxantrone. This review provides a comprehensive analysis of each of these medications in NMO and concludes with a set of recommended consensus practices.

KEYWORDS:

Neuromyelitis optica; aquaporin 4; drug therapy; immunosuppression

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