New Treatment Perspectives for Acute Relapses in Neuromyelitis Optica Spectrum Disorder

Neuromyelitis optica spectrum disorder (NMOSD) is a chronic autoimmune disease of the central nervous system, characterized by recurrent attacks of optic neuritis, transverse myelitis, brainstem, and/ or cerebral symptoms. Despite the current standard of care consisting of high-dose corticosteroids and therapeutic plasma exchange, many patients are left with a permanent neurological disability after each attack. With the recent advancements in understanding the pathogenic mechanisms involved in NMOSD relapses, possibilities to develop new targeted therapies are anticipated. To date, therapies targeted at inhibiting the complement cascade, inhibiting the vascular endothelial growth factor, inhibiting granulocyte migration and degranulation, and depleting B cells have been explored in phase I clinical trials, while other agents are being investigated in preclinical and early clinical trials. This review aims to discuss the potential targets for relapse treatment in NMOSD and provide the readers with a summary of the available data regarding some of the candidate agents for future application in clinical practice.