Hungarian consensus recommendations for diagnosis and treatment of neuromyelitis optica spectrum disorder

Abstract Background Although neuromyelitis optica spectrum disorder (NMOSD) is a rare autoimmune disease worldwide, early diagnosis and treatment are crucial for reducing permanent neurological disability. Four monoclonal antibodies (mAbs) – eculizumab, ravulizumab, satralizumab, and inebilizumab – have shown significant efficacy in randomized controlled trials in recent years. However, other immunosuppressive drugs, such as azathioprine, mycophenolate mofetil, rituximab, and tocilizumab, are also widely used off-label. In Hungary, access to the approved on-label mAb treatments is limited. Although treatment reimbursement policies vary across countries, regional or national guidelines can assist clinicians in effectively managing patients. Consequently, as an initiative of the Hungarian Neuroimmunology Society, 17 national neuroimmunology experts reached a consensus on eight recommendations using the Delphi method. Results Strong agreement (> 80%) was reached on six recommendations after two rounds (including general recommendations, off-label and approved mAb therapies, therapeutic switching, and pregnancy), on one recommendation after three rounds (treatment of relapses), and on another recommendation after four rounds (double-negative NMOSD). Conclusions we present this nationwide consensus protocol, aimed at standardizing the care of people with NMOSD in Hungary and fostering dialogue between healthcare regulators and clinicians.