Impact of early introduction of biologics on internal medications for neuromyelitis optica spectrum disorder

Objectives

Neuromyelitis optica spectrum disorder (NMOSD) can cause severe disability after a single attack. This study aimed to investigate the reduction of oral medications, including steroids, in patients using biologics within 1 year after the onset or relapse of NMOSD.

Methods

Patients with NMOSD who were using biologics and attending the Department of Neurology at St. Marianna University School of Medicine from November 2019 to February 2023 were enrolled. The patients were introduced to biologics within 1 year of their last relapses. The study examined whether these patients experienced clinical relapse, changes in prednisolone dosage of 5 mg/day or less and changes in the number of oral medications.

Results

A total of 14 patients were included. The mean prednisolone dosage was 17.5 ± 5.8 mg/day, and the mean number of medications was 6.2 ± 4.2. No relapse was reported in any patient after the introduction of biologics. The prednisolone dosage gradually decreased to 5.3 ± 2.9 mg/day and 3.1 ± 1.7 mg/day at 6 and 12 months, respectively, and the rates of achieving a prednisolone dosage of ≤5 mg/day at 6 and 12 months were 61.5% and 100%, respectively. The total number of medications decreased to 4.4 ± 4.6.

Conclusions

Biologics can be introduced early after NMOSD relapse to reduce prednisolone dosage and counteract polypharmacy. The high relapse prevention rate of biologics makes them a valuable option for preventing relapse in patients with NMOSD.