The standard of care for patients with neuromyelitis optica (NMO) has become highly unequal globally. Sufficient data have been published to demonstrate that NMO is a disabling—and at times, fatal—disease needing preventive immunosuppressive treatment. Since 2019, there are multiple regulatory authority-approved disease-modifying therapies (DMTs) for aquaporin-4 antibody seropositive NMO for patients. Reframing the picture of NMO globally is now needed. When considered as a disease of high mortality when left untreated, parallel programs to those for cancer, HIV/AIDS, or tuberculosis can be considered. Nine collective goals for rectifying global inequities in NMO diagnosis and treatment are proposed.
Genentech, Alexion and Horizon Therapeutics. Personal communications by e-mail, May 4 and 5, 2023. San Francisco, CA: Genentech, Boston, MA: Alexion, Dublin: Horizon Therapeutics, 2023.
2.
HughesDABourkeSJonesA, et al. Health utilities and costs for neuromyelitis optica spectrum disorder. Orphanet J Rare Dis2022; 17: 159.
3.
WingerchukDMHogancampWFO’BrienPC, et al. The clinical course of neuromyelitis optica (Devic’s syndrome). Neurology1999; 53(5): 1107–1114.
4.
PittockSJBertheleAFujiharaK, et al. Eculizumab in aquaporin-4-positive neuromyelitis optica spectrum disorder. N Engl J Med2019; 381(7): 614–625.
5.
YamamuraTKleiterIFujiharaK, et al. Trial of satralizumab in neuromyelitis optica spectrum disorder. N Engl J Med2019; 381(22): 2114–2124.
6.
CreeBACBennettJLKimHJ, et al. Inebilizumab for the treatment of neuromyelitis optica spectrum disorder (N-MOmentum): A double-blind, randomised placebo-controlled phase 2/3 trial. Lancet2019; 394(10206): 1352–1363.
7.
TraboulseeAGreenbergBMBennettJL, et al. Safety and efficacy of satralizumab monotherapy in neuromyelitis optica spectrum disorder: A randomised, double-blind, multicentre, placebo-controlled phase 3 trial. Lancet Neurol2020; 19(5): 402–412.
8.
HuangWWangLXiaJ, et al. Efficacy and safety of azathioprine, mycophenolate mofetil, and reduced dose of rituximab in neuromyelitis optica spectrum disorder. Eur J Neurol2022; 29(8): 2343–2354.
9.
MaJYuHWangH, et al. Evaluation of effect of empirical attack-preventive immunotherapies in neuromyelitis optica spectrum disorders: An update systematic review and meta-analysis. J Neuroimmunol2022; 363: 577790.
10.
MusubireAKDerdelinckxJReyndersT, et al. Neuromyelitis optica spectrum disorders in Africa: A systematic review. Neurol Neuroimmunol Neuroinflamm2021; 8(6): e1089.
11.
HuangWZhangBaoJChangX, et al. Neuromyelitis optica spectrum disorder in China: Quality of life and medical care experience. Mult Scler Relat Disord2020; 46: 102542.
12.
ViswanathanS. Management of Idiopathic CNS inflammatory diseases during the COVID-19 pandemic: Perspectives and strategies for continuity of care from a South East Asian Center with limited resources. Mult Scler Relat Disord2020; 44: 102353.
13.
SachdevaJGoyalMKSinghR, et al. Neuromyelitis optica spectrum disorders in North Indian population: Experience from a tertiary care center. Neurol India2022; 70(4): 1500–1505.
14.
GayeNMFallMDiopAM, et al. Neuromyelitis optica spectrum disorders (NMO-SD) in a Sub-Saharan Africa country: A preliminary study of sixteen Senegalese cases. Mult Scler Relat Disord2019; 27: 179–183.
15.
IbrahimEAAGammerFGassoumA. Neuromyelitis optica: A pilot study of clinical presentation and status of serological biomarker AQP4 among patients admitted to a tertiary centre in NCNS, Sudan. BMC Neurosci2020; 21: 9.
PrainKWoodhallMVincentA, et al. AQP4 antibody assay sensitivity comparison in the era of the 2015 diagnostic criteria for NMOSD. Front Neurol2019; 10: 1028.
18.
RiceDRNishiyamaSPardoS, et al. A point-of-care diagnostic test for aquaporin-4 antibody seropositive neuromyelitis optica. Mult Scler Relat Disord2022; 60: 103716.
19.
Garcia-GonzalezPBoultbeePEpsteinD. Novel humanitarian aid program: The Glivec international patient assistance program–lessons learned from providing access to breakthrough targeted oncology treatment in low- and middle-income countries. J Glob Oncol2015; 1(1): 37–45.
