水通道蛋白4抗体阳性视神经脊髓炎谱系疾病治疗国际共识解读

Interpret of international Delphi consensus on the management of aquaporin-4 immunoglobulin G seropositive neuromyelitis optica spectrum disorder

视神经脊髓炎谱系疾病(NMOSD)是一种少见的脱髓鞘性中枢神经系统自身免疫性疾病。目前,国际上共有三种单克隆抗体获批应用于治疗水通道蛋白4(AQP4)抗体阳性的NMOSD,包括依库珠单抗(eculizumab)、伊奈利珠单抗(inebilizumab)和萨特利珠单抗(satralizumab)。2023年5月31日Neurol Neuroimmunol Neuroinflamm杂志发表了关于这三种单抗类药物治疗AQP4抗体阳性NMOSD的国际德尔菲(Delphi)共识,此共识经24位Delphi小组专家的2轮投票共产生25个条目。伊奈利珠单抗和萨特丽珠单抗已在国内上市,临床中超适应证药物包括免疫抑制剂和单抗类药物,但对于如何应用单抗类药物和NMOSD的慢性期管理仍存在很大不足。因此,针对该共识进行解读,重点介绍初始使用单抗类药物、单抗类药物和免疫抑制剂之间的转换,以及特殊人群应用及其安全性,有助于提高眼科及神经内科医师对NMOSD单抗类药物的规范性和有效性应用。

Neuromyelitis optica spectrum disorder(NMOSD)is a rare debilitating autoimmune disease of the central nervous system.Three monoclonal antibodies were recently approved as maintenance therapies for aquaporin-4 immunoglobulin G(AQP4-IgG)seropositive NMOSD(eculizumab,inebilizumab,and satralizumab).Neurol Neuroimmunol Neuroinflamm published international Delphi consensus on the management of AQP4-IgG+NMOSD in May 31,2023.Twenty-five statements reached consensus after two voting rounds by 24 Delphi panel experts.Inebilizumab and satralizumab have been listed in China,and off-label immunosuppressants and biologics are also used in clinical practice.However,there are no standard treatment recommendations in use of these biologics and maintenance therapy of NMOSD.Therefore,the interpretation of this consensus,focusing on the initial use of monoclonal drugs,the conversion between monoclonal drugs and immunosuppressants,as well as the application and safety of special populations,is conducive to improving the normative and effective use of of monoclonal drugs in NMOSD y ophthalmologists and neurologists.