2025 年 42 巻 5 号 p. 807-811
Recent advances and new knowledge in neuromyelitis optica spectrum disorder (NMOSD) and myelin oligodendrocyte glycoprotein antibody–associated disease (MOGAD) were reviewed.
In NMOSD, the real–world treatment patterns and relapse in satralizumab–treated Japanese patients reported a majority of patients were relapse–free after initiating satralizumab treatment and the number of glucocorticoid–free patients without relapse increased over time under continuous satralizumab prescription. The real–world safety and effectiveness of satralizumab in Japanese patients based on post–marketing surveillance of clinical use reported satralizumab was found to be safe, well tolerated, and effective, and the results are consistent with those of clinical trials. In inebilizumab, end–of–study analysis of the N–MOmentum trial, including the randomised controlled period and open–label extension period, showed continued and sustained clinical benefits of long–term inebilizumab treatment. In eculizumab, evaluation of effectiveness and safety in routine clinical care in Europe showed an increased risk of attacks after the first vaccination and fatal systemic infections during eculizumab.
In MOGAD, the study about an optimal oral corticosteroid regimen at the onset to delay time to first relapse was reported. As results, in patients dosed ≥12.5 mg/day for at least 3 months, hazard of relapse was reduced corresponding to an 88% reduction in relapse risk compared with those never treated in this range. Authors concluded the optimal dose to delay first relapse is 12.5 mg of prednisone daily in adults for a minimum of 3 months. The study investigating the association of time to treat the first attack with relapse risk and MOG–IgG serostatus reported both the time to treatment of the first attack and immunosuppressant maintenance treatment were independently associated with the risk of relapse, and the former was also associated with MOG–IgG seronegative conversion, suggesting the association between timing of acute treatment for the first attack and the long–term prognosis. The study about the long–term outcomes of adult patients with MOGAD and factors affecting relapse risk and neurologic outcomes reported the highest risk of a relapse in MOGAD occurred early, and in multivariate analysis, initiation of maintenance treatment after the first attack was associated with a lower relapse risk.
