Neuro-ophthalmology CE/CME ACCREDITED Watch Time: 64 mins

touchSATELLITE SYMPOSIUM Considering the complete picture in neuromyelitis optica spectrum disorder: Optimizing diagnosis and management to improve patient outcomes

Watch three leading experts discuss diagnosis, treatment and care provision for patients with neuromyelitis optica spectrum disorder (NMOSD), with updates on the latest data for immunotherapy treatment options and guidance on how to support the holistic management of patients through multidisciplinary teams.

Prof. Sean Pittock

Mayo Clinic, Rochester, MN, USA

CHAIR
Panelists:
Dr Amy Kunchok, Prof. Dean Wingerchuk
Watch Time: 04:02

Prof. Sean Pittock opens the virtual symposium and sets the scene for this discussion on optimizing diagnosis and management for patients with NMOSD.
 
Watch Time: 12:06

Prof. Sean Pittock and Dr Amy Kunchok discuss the diagnosis of NMOSD, with particular focus on MRI findings and testing for AQP4-IgG.
 
Watch Time: 16:21

Prof. Sean Pittock and Prof. Dean Wingerchuk review the latest data for immunotherapies for NMOSD, and describe the various factors that influence treatment choice.
 
Watch Time: 16:19

The three faculty discuss the importance of a holistic approach to therapy for patients with NMOSD, encompassing the complexity and wide range of symptoms associated with NMOSD and the role of multidisciplinary teams in supporting patient care.

 
Watch Time: 15:10

The three expert faculty answer important questions raised by our audience on the diagnosis and treatment of patients with NMOSD.

 
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Overview & Learning Objectives
Overview

In this touchSATELLITE SYMPOSIUM activity, leading experts in neuromyelitis optica spectrum disorder (NMOSD) discuss the importance of making an accurate and timely diagnosis, as well as the need for appropriate application of the latest data for immunotherapies. They go on to highlight how multidisciplinary teams can support the holistic management of patients with NMOSD for improved outcomes.

This activity is jointly provided by USF Health and touchIME. read more

Target Audience

This activity has been designed to meet the educational needs of neurologists, neuro-immunologists, neuroradiologists and ophthalmologists, including neuro-ophthalmologists and specialist neurology nurses, who are active in the management of patients with NMOSD.

Disclosures

USF Health adheres to the Standards for Integrity and Independence in Accredited Continuing Education. All individuals in a position to influence content have disclosed to USF Health any financial relationship with an ineligible organization. USF Health has reviewed and mitigated all relevant financial relationships related to the content of the activity.  The relevant relationships are listed below. All individuals not listed have no relevant financial relationships.

Faculty

Prof. Sean Pittock discloses: Advisory board and panel fees from Alexion Pharmaceuticals Inc., F. Hoffmann-La Roche AG, Genentech and UCB Pharma. Consultant fees from Alexion Pharmaceuticals Inc., EUROIMMUN, MedImmune/Viela Bio (all compensation paid directly to the Mayo Clinic); Prime Therapeutics, Roche/Genentech, Sage Therapeutics, UCB Pharma (personal compensation); Astellas Pharma Inc (compensation to the Mayo Clinic and personal). Grants and research support from AEA, Alexion Pharmaceuticals Inc., Grifols, Guthy-Jackson Charitable Foundation, MedImmune/Viela Bio and National Institutes of Health (all compensation is paid directly to the Mayo Clinic).

Dr Amy Kunchok discloses: Advisory board or panel fees from Genentech.

Prof. Dean Wingerchuk discloses: Advisory board or panel fees from Biogen, Genentech, Horizon Therapeutics, Mitsubishi Tanabe Pharma Corp., Roche, UCB Pharma and Viela Bio. Grants and research support from Alexion Pharmaceuticals Inc. and Terumo BCT Inc.

Content reviewer

Janice Yvonne Maldonado, MD has no financial interests/relationships or affiliations in relation to this activity.

Touch Medical Director

Kathy Day has no financial interests/relationships or affiliations in relation to this activity.

USF Health Office of Continuing Professional Development and touchIME staff have no financial interests/relationships or affiliations in relation to this activity.

Requirements for Successful Completion

In order to receive credit for this activity, participants must review the content and complete the post-test and evaluation form. Statements of credit are awarded upon successful completion of the post-test and evaluation form.

If you have questions regarding credit please contact cpdsupport@usf.edu 

Accreditations

Physicians

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through a joint providership of USF Health and touchIME. USF Health is accredited by the ACCME to provide continuing medical education for physicians.

USF Health designates this enduring material for a maximum of 1.25 AMA PRA Category 1 CreditTM.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

The European Union of Medical Specialists (UEMS) – European Accreditation Council for Continuing Medical Education (EACCME) has an agreement of mutual recognition of continuing medical education (CME) credit with the American Medical Association (AMA). European physicians interested in converting AMA PRA Category 1 CreditTM into European CME credit (ECMEC) should contact the UEMS (www.uems.eu)

Advanced Practice Providers

Physician Assistants may claim a maximum of 1.25 Category 1 credits for completing this activity. NCCPA accepts AMA PRA Category 1 CreditTM from organizations accredited by ACCME or a recognized state medical society.

The AANPCP accepts certificates of participation for educational activities approved for AMA PRA Category 1 CreditTM by ACCME-accredited providers. APRNs who participate will receive a certificate of completion commensurate with the extent of their participation.

Date of original release: 24 March 2022. Date credits expire: 24 March 2023.

If you have any questions regarding credit please contact cpdsupport@usf.edu

Learning Objectives

After watching this activity, participants should be better able to:

  • Describe the clinical manifestations of neuromyelitis optica spectrum disorder (NMOSD), the typical MRI findings and differential diagnoses
  • Analyse the treatment options for the prevention of NMOSD attacks and their selection criteria
  • Determine strategies for the holistic management of the broad range of symptoms experienced by patients with NMOSD
Faculty & Disclosures
Prof. Sean Pittock

Mayo Clinic, Rochester, MN, USA

Prof. Sean Pittock is Director of the Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology and the Mayo Clinic Neuroimmunology Research Laboratory in Rochester, MN, USA. read more

His specific areas of focus include multidisciplinary, collaborative research into autoimmune neurological disorders, neuromyelitis optica spectrum disorder, and autoimmune gastrointestinal dysmotility.

Prof. Sean Pittock discloses: Advisory board and panel fees from Alexion Pharmaceuticals Inc., F. Hoffmann-La Roche AG, Genentech and UCB Pharma. Consultant fees from Alexion Pharmaceuticals Inc., EUROIMMUN, MedImmune/Viela Bio (all compensation paid directly to the Mayo Clinic); Prime Therapeutics, Roche/Genentech, Sage Therapeutics, UCB Pharma (personal compensation); Astellas Pharma Inc (compensation to the Mayo Clinic and personal). Grants and research support from AEA, Alexion Pharmaceuticals Inc., Grifols, Guthy-Jackson Charitable Foundation, MedImmune/Viela Bio and National Institutes of Health (all compensation is paid directly to the Mayo Clinic).
Dr Amy Kunchok

Cleveland Clinic, Cleveland, OH, USA

Dr Amy Kunchok specializes in multiple sclerosis and autoimmune neurological disorders, and is the director of the autoimmune neurology program at the Cleveland Clinic.

Dr Amy Kunchok discloses: Advisory board or panel fees from Genentech.
Prof. Dean Wingerchuk

Mayo Clinic, Phoenix and Scottsdale, AZ, USA

Prof. Dean Wingerchuk is a neurologist and clinical epidemiologist with specialty expertise in neuroimmunology, and is Professor and Chair of the Department of Neurology at Mayo Clinic in Phoenix and Scottsdale in Arizona, USA. His clinical and research interests focus on neuromyelitis optica spectrum disorder and multiple sclerosis. 

Prof. Dean Wingerchuk discloses: Advisory board or panel fees from Biogen, Genentech, Horizon Therapeutics, Mitsubishi Tanabe Pharma Corp., Roche, UCB Pharma and Viela Bio. Grants and research support from Alexion Pharmaceuticals Inc. and Terumo BCT Inc.
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This Activity Is Funded By:

An independent medical education grant from Alexion Pharmaceuticals.
This medical education is jointly provided by USF Health and touchIME.

The information provided by this CME activity is for continuing education purposes only and is not meant to substitute for the independent medical/clinical judgment of a healthcare provider relative to diagnostic and treatment options of a specific patient’s medical condition.

USF is an Equal Opportunity / Affirmative Action / Equal Access Institution.

USF Health is accredited by the Accreditation Council for Continuing Medical Education, the American Nurses Credentialing Center and the Accreditation Council for Pharmacy Education to provide continuing education to healthcare professionals. As an accredited provider, USF Health is required to disclose personal information to relevant accredited bodies that certify CME to process credits/contact hours, comply with reporting requirements, and for internal recordkeeping and regulatory purposes. USF Health does not share or sell any individual’s contact information or unique identifiers to any commercial supporter, advertiser, or third party without the specific permission of the individual.

Unapproved products or unapproved uses of approved products may be discussed by the faculty; these situations may reflect the approval status in one or more jurisdictions. The presenting faculty have been advised by touchIME and USF Health to ensure that they disclose any such references made to unlabelled or unapproved use. No endorsement by touchIME or USF Health of any unapproved products or unapproved uses is either made or implied by mention of these products or uses in touchIME or USF Health activities. touchIME and USF Health accept no responsibility for errors or omissions.

This content is intended for healthcare professionals.

Date of original release: 24 March 2022. Date credits expire: 24 March 2023.

This content is intended for healthcare professionals only. Please confirm that you are a healthcare professional.

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Question 1/5
Which of the following MRI lesion characteristics are indicative of NMOSD, but not MS or MOGAD?

MOGAD, myelin oligodendrocyte glycoprotein antibody disease; MRI, magnetic resonance imaging; MS, multiple sclerosis; NMOSD, neuromyelitis optica spectrum disorder
 Correct

Lesions of ≥3 vertebral segments are associated with NMOSD, and are usually centrally located. Shorter lesions are usually seen in MS and MOGAD, and may resolve completely post attack in MS.

Abbreviations

MOGAD, myelin oligodendrocyte glycoprotein antibody disease; MS, multiple sclerosis; NMOSD, neuromyelitis optica spectrum disorder

Reference

Solomon JM, et al. Ther Adv Neurol Disord. 2021;14:doi: 10.1177/17562864211014389.

Question 2/5
Which of the following is necessary for the use of eculizumab, inebilizumab or satralizumab in patients with NMOSD?

AQP4-IgG, aquaporin-4 immunoglobulin G; MRI, magnetic resonance imaging; NMOSD, neuromyelitis optica spectrum disorder.
 Correct

Eculizumab, inebilizumab and satralizumab are all indicated for AQP4-IgG-positive NMOSD.1–3 Longitudinally extensive transverse myelitis and bright spotty lesions on T2 MRI are both associated with NMOSD,4 but are not contingent for the use of immunotherapy. Acute disseminated encephalomyelitis is associated with MOGAD.5 

Abbreviations

AQP4-IgG, aquaporin-4 immunoglobulin G; MOGAD, myelin oligodendrocyte glycoprotein antibody disease; MRI, magnetic resonance imaging; NMOSD, neuromyelitis optica spectrum disorder 

References

  1. Eculizumab PI. Available at: www.accessdata.fda.gov/drugsatfda_docs/label/2019/125166s431lbl.pdf (accessed 17 February 2022).
  2. Inebilizumab PI. Available at: www.accessdata.fda.gov/drugsatfda_docs/label/2020/761142s000lbl.pdf (accessed 17 February 2022).
  3. Satralizumab PI. Available at: www.accessdata.fda.gov/drugsatfda_docs/label/2020/761149s000lbl.pdf (accessed 17 February 2022).
  4. Solomon JM, et al. Ther Adv Neurol Disord. 2021;14:1–18.
  5. López-Chiriboga AS, et al. JAMA Neurol. 2018;75:1355–63.
Question 3/5
Your patient is a 45-year-old woman who has experienced ocular pain and blurred vision in one eye, plus nausea and vomiting for the past 2 weeks. Her MRI scan reveals a lesion in the dorsal medulla involving the area postrema. What would be your next consideration to make a diagnosis?

AQP4-IgG, aquaporin-4 immunoglobulin G; ELISA, enzyme-linked immunosorbent assay; MRI, magnetic resonance imaging; NMOSD, neuromyelitis optica spectrum disorder
 Correct

These symptoms suggest two of the core symptoms of NMOSD (optic neuritis and APS), and the diagnosis could be confirmed with a positive serum AQP4-IgG assay.1 Cell-based AQP4-IgG assays are more sensitive and specific than ELISAs.2

Abbreviations

APS, area postrema syndrome; AQP4-IgG, aquaporin-4 immunoglobulin G; ELISA, enzyme-linked immunosorbent assay; NMOSD, neuromyelitis optica spectrum disorder

References

  1. Wingerchuk DM, et al. Neurology. 2015;85:177–89.
  2. Prain K, et al. Front Neurol. 2019;10:1028.
Question 4/5
Your patient from the previous question returns a positive AQP4-IgG assay and you diagnose NMOSD. Given that this was her first attack, what is the most reasonable course of action governing therapy choice with regard to optimal prevention of further attacks?

AQP4-IgG, aquaporin-4 immunoglobulin G; NMOSD, neuromyelitis optica spectrum disorder
 Correct

Newer antibody agents have improved relapse prevention in AQP4-IgG-positive NMOSD, as shown in the open-label extension phases of clinical trials: 96% of patients were attack-free at ~4 years with eculizumab,1 87.7% of patients were attack-free at up to 4 years with inebilizumab,2 and there was a 66% reduction in risk of relapse at 132 weeks with satralizumab.3

Abbreviations

AQP4-IgG, aquaporin-4 immunoglobulin G; NMOSD, neuromyelitis optica spectrum disorder

References

  1. Pittock SJ, et al. Mult Scler. 2022;28:480–6. 
  2. Cree BAC, et al. Presented at: American Academy of Neurology Annual Meeting (virtual). 17–22 April 2021. Abstr P15.076.
  3. Haskova Z, et al. Investigative Ophthalmology & Visual Science. 2021;62:3475.
Question 5/5
Which approach is most suitable for patients who are experiencing NMOSD-associated chronic pain with associated fatigue, anxiety and depression?

NMOSD, neuromyelitis optica spectrum disorder
 Correct

Chronic pain, including nociceptive, neuropathic or spasticity-associated pain, is highly prevalent in patients with NMOSD and carries a considerable quality-of-life burden with reduced scores for activities of daily living.1 Pain attacks without painless periods are typical for NMOSD and have the most severe impact; pain severity is associated with increased healthcare utilization, higher relapse rate and other symptoms such as fatigue, anxiety and depression.1,2 Symptomatic treatment may be insufficient to reduce pain intensity and improve the patient’s quality of life.3 Referral to a pain specialist may be required for patients who continue to have severe chronic pain.2

Abbreviation

NMOSD, neuromyelitis optica spectrum disorder

References

  1. Ayzenberg I, et al. Neurol Neuroimmunol Neuroinflamm. 2021;8:e985.
  2. Fujihara K, et al. J Neurol Sci. 2021;428:117546.  
  3. Asseyer S, et al. Front Neurol. 2020;11:778.
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