Neuromyelitis optic spectrum disorders (NMOSD): from pathogenesis to targeted therapy

In the review, we present the main pathogenetic mechanisms of the development of neuromyelitis optic spectrum disorders (NMOSD) associated with the appearance of anti-aquaporin-4 (APQ4-IgG) autoantibodies: damage to astrocytes, including complement-dependent and complement-independent cytotoxicity, with subsequent damage to oligodentrocytes, axons, and demyelination. Based on these data, the main directions of pathogenetic treatment of NMOSD are discussed, which has two main directions: treatment of exacerbations and prevention of relapses. In recent years, the second direction has been actively developing, and two drugs of monoclonal antibodies have been approved in Russia, which have as their main indication the treatment of patients with NMOSD and antibodies to APQ4-IgG: e eculizumab and satralizumab. The remaining drugs are still prescribed in necessary cases by decision of medical commissions.