There is no cure for neuromyelitis optica (NMO) at this time. The standard of care for an initial attack of NMO includes the following:
- Intravenous (into the vein) high-dose corticosteroids (methylprednisolone)
- Plasma Exchange (PLEX) if no improvement occurs with corticosteroids. The goal of PLEX is to lower the level of NMO-IgG in the blood. PLEX involves removing blood from the body through a needle and tubing. Through a series of steps, the plasma (the liquid part of the blood) is separated from blood cells and replaced with an artificial plasma substitute; the plasma substitute and blood cells are combined and returned to the body through an intravenous line. The procedure lasts several hours and may be repeated multiple times over a number of days.
Because the likelihood of recurrence is greater than 90 percent and attacks are generally severe, ongoing treatment to suppress the immune system is considered necessary. Two drugs have been approved by the US Food and Drug Administration (FDA) specifically for treatment of anti-AQP4 positive NMO:
- Soliris (eculizumab)
- Uplizna (inebilizumab)
Other drugs used off-label to prevent attacks include:
- Rituxan (rituximab)
- CellCept (mycophenolate mofetil)
- Imuran, Azasan (azathioprine)
about the benefits and risks of these medications.
Reviewed by Elias Sotirchos, MD November 2019