The role of neuroimmunology subspecialty in disease management of patients with neuromyelitis optica spectrum disorder

Neuromyelitis optica spectrum disorder (NMOSD) is a severe autoimmune inflammatory disease of the central nervous system (CNS) that requires specialized management. Although the role of subspecialty management has been established in various neurological conditions, the impact of neuroimmunology subspecialty (NIS) management on NMOSD patient outcomes remains inadequately explored.

A retrospective analysis was conducted on 188 NMOSD patients, stratifying them into groups based on their management pathway: initial visit in NIS, initial visit in non-neuroimmunology subspecialty (NNIS), NNIS-to-NIS transfer, and last visit in either NIS or NNIS. Primary outcome measures included annualized relapse rate (ARR), Expanded Disability Status Scale (EDSS) scores.

Patients initially presenting to NIS IV demonstrated a lower ARR (median: 0.39, IQR: 0.31–0.51, 95% confidence interval (CI): 0.33–0.45) compared to other groups at last follow-up. For transfer patients, ARR significantly decreased post-transfer (p < 0.001). Patients in NIS IV group had the lowest EDSS scores (median: 1.3, IQR: 1.0–2.0, 95% CI: 1.0–2.0) compared to other groups. Both initial presentation to NIS (OR:0.50, 95%CI:0.26–0.97, p = 0.039) and subsequent transfer to NIS management (OR:0.41, 95%CI:0.21–0.81, p = 0.010) were associated with lower EDSS scores.

NIS management significantly improves outcomes in NMOSD patients, as evidenced by lower relapse rates, reduced disability scores, and higher utilization of advanced therapeutics.