Comparing First-Line Immunosuppressants for Neuromyelitis Optica Spectrum Disorder

Immunosuppressants are widely used to prevent relapse in patients with neuromyelitis optica spectrum disorder (NMOSD). However, the optimal first-line treatment for these patients with off-label therapies remains unclear.

To compare the efficacy and safety of three off-label immunosuppressants in this setting, French investigators conducted a multicenter, retrospective, cohort study of 136 treatment-naive NMOSD patients with positive aquaporin 4 or myelin oligodendrocyte glycoprotein antibodies. Of these, 46% received rituximab, 31% received mycophenolate, and 17% received azathioprine, within 3 years of disease onset.

After at least 1 year of follow-up, freedom from relapse was achieved in 86% of all patients at 1 year and in 72% at 3 years.…