Treatment of multiple sclerosis and neuromyelitis optica–spectrum disorders

Abstract

Myelin “wraps” around neural axons not only to electrically insulate, but also to metabolically support them. More than 20,000 Japanese patients are suffering from demyelinating diseases of the central nervous system (CNS), including multiple sclerosis (MS) and neuromyelitis optica–spectrum disorders (NMOSD). The etiology of MS remains unknown, and therefore no curative therapy is available at present. Relapses and remissions characterize MS and a number of disease–modifying drugs (DMDs) reducing relapse rate have been developed, six of which are also available in Japan. An appropriate selection of DMD most suitable for individual MS patients is mandatory for the better prognosis. On the other hand, NMOSD cases are mostly caused by pathogenic autoantibodies including anti–aquaporin4 (AQP4) antibodies. Similarly to other autoimmune diseases, the use of systemic steroids or immunosuppressive medicines mainstay as a therapeutic strategy to halt the production of such autoantibodies. In both MS and NMOSD, anti–inflammatory therapies such as intravenous methylprednisolone therapy (IVMP) and plasmapheresis are considered during the acute inflammatory phase. In this article, therapies for MS and NMOSD will be reviewed.