title: Treatment of Neuromyelitis Optica: Review and Recommendations.
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.
authors.affiliation: Johns Hopkins University, Baltimore MD, USA.
authors.forename: Dorlan J
authors.initials: DJ
authors.lastname: Kimbrough
authors.affiliation: Tohoku University School of Medicine, Sendai, Japan.
authors.forename: Kazuo
authors.initials: K
authors.lastname: Fujihara
authors.affiliation: The Walton Centre for Neurology and Neurosurgery, Liverpool, United Kingdom.
authors.forename: Anu
authors.initials: A
authors.lastname: Jacob
authors.affiliation: Medical School of the Federal University of Minas Gerais, Belo Horizonte MG, Brazil.
authors.forename: Marco A
authors.initials: MA
authors.lastname: Lana-Peixoto
authors.affiliation: John Radcliffe Hospital, Oxford University, Oxford, UK.
authors.forename: Maria Isabel
authors.initials: MI
authors.lastname: Leite
authors.affiliation: Johns Hopkins University, Baltimore MD, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Levy
authors.affiliation: Service de Neurologie A, Université de Lyon, Lyon, France.
authors.forename: Romain
authors.initials: R
authors.lastname: Marignier
authors.affiliation: Tohoku University School of Medicine, Sendai, Japan.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Nakashima
authors.affiliation: John Radcliffe Hospital, Oxford University, Oxford, UK.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Palace
authors.affiliation: University Hospital of Strasbourg, Strasbourg, France.
authors.forename: Jérôme
authors.initials: J
authors.lastname: de Seze
authors.affiliation: University of Texas Southwestern, Dallas, TX, USA.
authors.forename: Olaf
authors.initials: O
authors.lastname: Stuve
authors.affiliation: National Pediatric Hospital Dr. Juan P. Garrahan, Buenos Aires, Argentina.
authors.forename: Silvia N
authors.initials: SN
authors.lastname: Tenembaum
authors.affiliation: University of British Columbia, Vancouver BC, Canada.
authors.forename: Anthony
authors.initials: A
authors.lastname: Traboulsee
authors.affiliation: University of California, San Francisco, San Francisco CA, USA.
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Waubant
authors.affiliation: Mayo Clinic, Rochester MN, USA.
authors.forename: Brian G
authors.initials: BG
authors.lastname: Weinshenker
authors.affiliation: Mayo Clinic, Scottsdale AZ, USA.
authors.forename: Dean M
authors.initials: DM
authors.lastname: Wingerchuk
keywords: Neuromyelitis optica; aquaporin 4; drug therapy; immunosuppression