Neurologist Filippi, ‘today more effective therapies for neuromyelitis optica’

2023-09-07 16:23:03

“Neuromyelitis optica is a serious, very serious disease, which mainly affects the optic nerves and the spinal cord, leading to being completely immobile and blind. A pathology in which zero tolerance towards relapses is necessary, because each new relapse can definitively compromising the patient’s clinical picture. We have historic drugs that reduce relapses by around 60%, now with this new molecule (inebilizumab, ed.) we can reduce relapses by 90-95%.” Thus Massimo Filippi, director of the Neurology Unit, of the Neurophysiology Service and of the Neurorehabilitation Unit of the Irccs San Raffaele Hospital in Milan, in his speech at the national conference ‘Change Direction in Nmosd’, dedicated to neuromyelitis spectrum disorder optics and new therapies, today and tomorrow in Rome at the Hotel Villa Pamphili.

At the moment “we have historical patients who have a clinical picture in which the main need is support for a quality of life that is now compromised – explains Filippi – The other clinical need starts from the drugs we have available. At the moment we have the possibility to treat one more patient in 3, going from 60 to 90% effectiveness. Unfortunately, these drugs can only be prescribed in the second line. We have a lot of data that tells us that the sooner we start the most effective treatment, the sooner we stop the degeneration of the disease. It also happens in multiple sclerosis.” However, “the paradox – the neurologist points out – is that at the moment we have to tell patients that before accessing the most effective drug they must wait until the first drug, which in any case has a cost, fails and leads them to have a second adverse event, which could be the fatal one, and which would completely compromise their faculties. Therefore, even if the second line treatment is more effective, the success is compromised by the damage of the second adverse event, when it is no longer needed”.

Neuromyelitis optica, “until a few years ago considered a type of multiple sclerosis, which was the most frequent pathology and therefore ‘relative’ of the Nmosd spectrum”, affects “women much more than men – underlines Filippi – with a 4 to 1. The reason? We don’t know it yet, but the hormonal structure certainly impacts the immune system and this applies to all autoimmune diseases, including multiple sclerosis and non-neurological autoimmune diseases.”