{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T14:48:36Z","timestamp":1791643716497,"version":"4.3.4"},"reference-count":72,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2022,4,9]],"date-time":"2022-04-09T00:00:00Z","timestamp":1649462400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJMS"],"abstract":"<jats:p>Neuromyelitis optica spectrum disorders (NMOSD) are rare neurologic autoimmune diseases that have a poor prognosis if left untreated. For many years, generic oral immunosuppressants and repurposed monoclonal antibodies that target the interleukin-6 pathway or B cells were the mainstays of drug treatment. Recently, these drug treatments have been complemented by new biologics developed and approved specifically for NMOSD. In principle, all of these drugs are effective, but treatment recommendations that take this into account are still pending. Instead, the choice of a drug may depend on other criteria such as drug safety or tolerability. In this review, we summarise current knowledge on the adverse effects of azathioprine, mycophenolate mofetil, rituximab, tocilizumab, eculizumab, satralizumab, and inebilizumab in NMOSD. Infections, cytopenias, and infusion-related reactions are most common, but the data are as heterogeneous as the manifestations are diverse. Nevertheless, knowledge of safety issues may facilitate treatment choices for individual patients.<\/jats:p>","DOI":"10.3390\/ijms23084154","type":"journal-article","created":{"date-parts":[[2022,4,9]],"date-time":"2022-04-09T05:13:08Z","timestamp":1649481188000},"page":"4154","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":41,"title":["Adverse Events in NMOSD Therapy"],"prefix":"10.3390","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3790-2334","authenticated-orcid":false,"given":"Katrin","family":"Giglhuber","sequence":"first","affiliation":[{"name":"Department of Neurology, School of Medicine, Technical University Munich, Klinikum Rechts der Isar, Ismaninger Str. 22, 81675 Muenchen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9650-6222","authenticated-orcid":false,"given":"Achim","family":"Berthele","sequence":"additional","affiliation":[{"name":"Department of Neurology, School of Medicine, Technical University Munich, Klinikum Rechts der Isar, Ismaninger Str. 22, 81675 Muenchen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,4,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1038\/s41572-020-0214-9","article-title":"Neuromyelitis optica","volume":"6","author":"Jarius","year":"2020","journal-title":"Nat. Rev. Dis. Primers"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2106","DOI":"10.1016\/S0140-6736(04)17551-X","article-title":"A serum autoantibody marker of neuromyelitis optica: Distinction from multiple sclerosis","volume":"364","author":"Lennon","year":"2004","journal-title":"Lancet"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1186\/1742-2094-9-14","article-title":"Contrasting disease patterns in seropositive and seronegative neuromyelitis optica: A multicentre study of 175 patients","volume":"9","author":"Jarius","year":"2012","journal-title":"J. Neuroinflamm."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"762","DOI":"10.1016\/S1474-4422(21)00218-0","article-title":"Myelin-oligodendrocyte glycoprotein antibody-associated disease","volume":"20","author":"Marignier","year":"2021","journal-title":"Lancet Neurol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1111\/nan.12574","article-title":"Review: Recent advances in the understanding of the pathophysiology of neuromyelitis optica spectrum disorder","volume":"46","author":"Chang","year":"2020","journal-title":"Neuropathol. Appl. Neurobiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1212\/WNL.0000000000001729","article-title":"International consensus diagnostic criteria for neuromyelitis optica spectrum disorders","volume":"85","author":"Wingerchuk","year":"2015","journal-title":"Neurology"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"759","DOI":"10.1038\/s41582-021-00568-8","article-title":"Hope for patients with neuromyelitis optica spectrum disorders\u2014From mechanisms to trials","volume":"17","author":"Pittock","year":"2021","journal-title":"Nat. Rev. Neurol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1212\/WNL.0b013e31822a2780","article-title":"Azathioprine: Tolerability, efficacy, and predictors of benefit in neuromyelitis optica","volume":"77","author":"Costanzi","year":"2011","journal-title":"Neurology"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1533","DOI":"10.1177\/1352458514525870","article-title":"Long-term efficacy, tolerability and retention rate of Azathioprine in 103 aquaporin-4 antibody-positive neuromyelitis optica spectrum disorder patients: A multicentre retrospective observational study from the UK","volume":"20","author":"Elsone","year":"2014","journal-title":"Mult. Scler."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1016\/j.msard.2019.05.011","article-title":"Efficacy and tolerability of Azathioprine for neuromyelitis optica spectrum disorder: A systematic review and meta-analysis","volume":"33","author":"Espiritu","year":"2019","journal-title":"Mult. Scler. Relat. Disord."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1590\/0004-282x-anp-2020-0041","article-title":"Long-term safety of Azathioprine for treatment of neuromyelitis optica spectrum disorders","volume":"79","author":"Gomes","year":"2021","journal-title":"Arq. Neuropsiquiatr."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"102484","DOI":"10.1016\/j.msard.2020.102484","article-title":"Efficacy and safety of Azathioprine for neuromyelitis optica spectrum disorders: A meta-analysis of real-world studies","volume":"46","author":"Luo","year":"2020","journal-title":"Mult. Scler. Relat. Disord."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1404","DOI":"10.1097\/MIB.0b013e318281f28f","article-title":"Safety of thiopurine therapy in inflammatory bowel disease: Long-term follow-up study of 3931 patients","volume":"19","author":"Chaparro","year":"2013","journal-title":"Inflamm. Bowel Dis."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"824","DOI":"10.1093\/rheumatology\/37.8.824","article-title":"Azathioprine and Cyclophosphamide in the treatment of Rheumatoid Arthritis","volume":"37","author":"Gaffney","year":"1998","journal-title":"Br. J. Rheumatol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2068","DOI":"10.1016\/j.transproceed.2004.07.057","article-title":"Safety of mycophenolate mofetil versus Azathioprine in renal transplantation: A systematic review","volume":"36","author":"Wang","year":"2004","journal-title":"Transplant. Proc."},{"key":"ref_16","unstructured":"(2022, March 02). Food and Drug Administration, US IMURAN Product Information, Available online: https:\/\/www.accessdata.fda.gov\/drugsatfda_docs\/label\/2018\/016324s039lbl.pdf."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1216","DOI":"10.1002\/pds.3320","article-title":"Signals of progressive multifocal leukoencephalopathy for immunosuppressants: A disproportionality analysis of spontaneous reports within the US Adverse Event Reporting System (AERS)","volume":"21","author":"Schmedt","year":"2012","journal-title":"Pharmacoepidemiol. Drug Saf."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"448","DOI":"10.1212\/CPJ.0b013e3182a78f82","article-title":"Simultaneous PML-IRIS and myelitis in a patient with neuromyelitis optica spectrum disorder","volume":"3","author":"Flanagan","year":"2013","journal-title":"Neurol. Clin. Pract."},{"key":"ref_19","first-page":"69","article-title":"Azathioprine and the neurologist","volume":"20","author":"McWilliam","year":"2020","journal-title":"Pract. Neurol."},{"key":"ref_20","unstructured":"(2022, March 02). Food and Drug Administration, US CELLCEPT Product Information, Available online: https:\/\/www.accessdata.fda.gov\/drugsatfda_docs\/label\/2019\/050722s040,050723s041,050758s037,050759s045lbl.pdf."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"16727","DOI":"10.1038\/s41598-020-73882-8","article-title":"Efficacy and safety of mycophenolate mofetil therapy in neuromyelitis optica spectrum disorders: A systematic review and meta-analysis","volume":"10","author":"Songwisit","year":"2020","journal-title":"Sci. Rep."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2066","DOI":"10.3389\/fimmu.2018.02066","article-title":"Low-Dose Mycophenolate Mofetil for Treatment of Neuromyelitis Optica Spectrum Disorders: A Prospective Multicenter Study in South China","volume":"9","author":"Huang","year":"2018","journal-title":"Front. Immunol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1097\/WNF.0000000000000131","article-title":"The Efficacy and Tolerability of Mycophenolate Mofetil in Treating Neuromyelitis Optica and Neuromyelitis Optica Spectrum Disorder in Western China","volume":"39","author":"Chen","year":"2016","journal-title":"Clin. Neuropharmacol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e1645","DOI":"10.1212\/WNL.0000000000009245","article-title":"Evaluation of efficacy and tolerability of first-line therapies in NMOSD","volume":"94","author":"Poupart","year":"2020","journal-title":"Neurology"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1372","DOI":"10.1001\/jamaneurol.2014.2057","article-title":"Mycophenolate mofetil in the treatment of neuromyelitis optica spectrum disorder","volume":"71","author":"Huh","year":"2014","journal-title":"JAMA Neurol."},{"key":"ref_26","unstructured":"(2022, March 02). Food and Drug Administration, US RITUXAN Product Information, Available online: https:\/\/www.accessdata.fda.gov\/drugsatfda_docs\/label\/2021\/103705s5465lbl.pdf#page=56."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1177\/1756285616632653","article-title":"An update on the evidence for the efficacy and safety of Rituximab in the management of neuromyelitis optica","volume":"9","author":"Collongues","year":"2016","journal-title":"Ther. Adv. Neurol. Disord."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1342","DOI":"10.1001\/jamaneurol.2016.1637","article-title":"Efficacy and Safety of Rituximab Therapy in Neuromyelitis Optica Spectrum Disorders: A Systematic Review and Meta-analysis","volume":"73","author":"Damato","year":"2016","journal-title":"JAMA Neurol"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Gao, F., Chai, B., Gu, C., Wu, R., Dong, T., Yao, Y., and Zhang, Y. (2019). Effectiveness of Rituximab in neuromyelitis optica: A meta-analysis. BMC Neurol., 19.","DOI":"10.1186\/s12883-019-1261-2"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"17562864211056710","DOI":"10.1177\/17562864211056710","article-title":"Adverse events of Rituximab in neuromyelitis optica spectrum disorder: A systematic review and meta-analysis","volume":"14","author":"Wang","year":"2021","journal-title":"Ther. Adv. Neurol. Disord."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"989","DOI":"10.1001\/jamaneurol.2015.1276","article-title":"Treatment Outcomes With Rituximab in 100 Patients With Neuromyelitis Optica: Influence of FCGR3A Polymorphisms on the Therapeutic Response to Rituximab","volume":"72","author":"Kim","year":"2015","journal-title":"JAMA Neurol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"2003","DOI":"10.1007\/s00415-017-8590-0","article-title":"Comparison of the efficacy of Azathioprine and Rituximab in neuromyelitis optica spectrum disorder: A randomised clinical trial","volume":"264","author":"Nikoo","year":"2017","journal-title":"J. Neurol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1016\/S1474-4422(20)30066-1","article-title":"Safety and efficacy of Rituximab in neuromyelitis optica spectrum disorders (RIN-1 study): A multicentre, randomised, double-blind, placebo-controlled trial","volume":"19","author":"Tahara","year":"2020","journal-title":"Lancet Neurol."},{"key":"ref_34","first-page":"1","article-title":"Rituximab for the Treatment of Neuromyelitis Optica Spectrum Disorder","volume":"1","author":"Banerjee","year":"2021","journal-title":"Can. Agency Drugs Technol. Health"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1156","DOI":"10.1001\/archneurol.2011.103","article-title":"Rituximab-associated progressive multifocal leukoencephalopathy in rheumatoid arthritis","volume":"68","author":"Clifford","year":"2011","journal-title":"Arch. Neurol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1443","DOI":"10.1001\/archneur.65.11.noc80069","article-title":"Treatment of Neuromyelitis Optica With Rituximab","volume":"65","author":"Jacob","year":"2008","journal-title":"Arch. Neurol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1310","DOI":"10.1212\/WNL.0b013e3182152881","article-title":"Long-term follow-up of patients with neuromyelitis optica after repeated therapy with rituximab","volume":"76","author":"Pellkofer","year":"2011","journal-title":"Neurology"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"e977","DOI":"10.1212\/NXI.0000000000000977","article-title":"Rituximab-Induced Hypogammaglobulinemia and Infections in AQP4 and MOG Antibody-Associated Diseases","volume":"8","author":"Avouac","year":"2021","journal-title":"Neurol. Neuroimmunol. Neuroinflamm."},{"key":"ref_39","unstructured":"(2022, March 02). Food and Drug Administration, US ACTEMRA Product Information, Available online: https:\/\/www.accessdata.fda.gov\/drugsatfda_docs\/label\/2017\/125276s114lbl.pdf."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1302","DOI":"10.1212\/WNL.0000000000000317","article-title":"Efficacy of the anti\u2013IL-6 receptor antibody tocilizumab in neuromyelitis optica","volume":"82","author":"Araki","year":"2014","journal-title":"Neurology"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"101920","DOI":"10.1016\/j.msard.2019.101920","article-title":"Effectiveness of subcutaneous Tocilizumab in neuromyelitis optica spectrum disorders","volume":"39","author":"Lotan","year":"2019","journal-title":"Mult. Scler. Relat. Disord."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"102483","DOI":"10.1016\/j.msard.2020.102483","article-title":"Off-label use of Tocilizumab in neuromyelitis optica spectrum disorders and MOG-antibody-associated diseases: A case-series","volume":"46","author":"Rigal","year":"2020","journal-title":"Mult. Scler. Relat. Disord."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"e1100","DOI":"10.1212\/NXI.0000000000001100","article-title":"Interleukin-6 Receptor Blockade in Treatment-Refractory MOG-IgG-Associated Disease and Neuromyelitis Optica Spectrum Disorders","volume":"9","author":"Ringelstein","year":"2022","journal-title":"Neurol. Neuroimmunol. Neuroinflamm."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1016\/S1474-4422(20)30070-3","article-title":"Safety and efficacy of Tocilizumab versus Azathioprine in highly relapsing neuromyelitis optica spectrum disorder (TANGO): An open-label, multicentre, randomised, phase 2 trial","volume":"19","author":"Zhang","year":"2020","journal-title":"Lancet Neurol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"220","DOI":"10.2174\/18756190MTA2cMjAm1","article-title":"Anti-IL-6 Therapies for Neuromyelitis Optica Spectrum Disorders: A Systematic Review of Safety and Efficacy","volume":"19","author":"Lotan","year":"2021","journal-title":"Curr. Neuropharmacol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"102421","DOI":"10.1016\/j.msard.2020.102421","article-title":"A meta-analysis to determine the efficacy and safety of Tocilizumab in neuromyelitis optica spectrum disorders","volume":"45","author":"Xie","year":"2020","journal-title":"Mult. Scler. Relat. Disord."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"614","DOI":"10.1056\/NEJMoa1900866","article-title":"Eculizumab in Aquaporin-4-Positive Neuromyelitis Optica Spectrum Disorder","volume":"381","author":"Pittock","year":"2019","journal-title":"N. Engl. J. Med."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"554","DOI":"10.1016\/S1474-4422(13)70076-0","article-title":"Eculizumab in AQP4-IgG-positive relapsing neuromyelitis optica spectrum disorders: An open-label pilot study","volume":"12","author":"Pittock","year":"2013","journal-title":"Lancet Neurol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1088","DOI":"10.1002\/ana.26049","article-title":"Long-Term Safety and Efficacy of Eculizumab in Aquaporin-4 IgG-Positive NMOSD","volume":"89","author":"Wingerchuk","year":"2021","journal-title":"Ann. Neurol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"102641","DOI":"10.1016\/j.msard.2020.102641","article-title":"Benefits of Eculizumab in AQP4+ neuromyelitis optica spectrum disorder: Subgroup analyses of the randomised controlled phase 3 PREVENT trial","volume":"47","author":"Palace","year":"2021","journal-title":"Mult. Scler. Relat. Disord."},{"key":"ref_51","unstructured":"(2022, March 02). Food and Drug Administration, US SOLIRIS Product Information, Available online: https:\/\/www.accessdata.fda.gov\/drugsatfda_docs\/label\/2019\/125166s431lbledt.pdf."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"734","DOI":"10.15585\/mmwr.mm6627e1","article-title":"High Risk for Invasive Meningococcal Disease Among Patients Receiving Eculizumab (Soliris) Despite Receipt of Meningococcal Vaccine","volume":"66","author":"McNamara","year":"2017","journal-title":"MMWR Morb. Mortal. Wkly. Rep."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1568","DOI":"10.1016\/j.ekir.2019.07.016","article-title":"Eculizumab Safety: Five-Year Experience From the Global Atypical Hemolytic Uremic Syndrome Registry","volume":"4","author":"Rondeau","year":"2019","journal-title":"Kidney Int. Rep."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"402","DOI":"10.1016\/S1474-4422(20)30078-8","article-title":"Safety and efficacy of satralizumab monotherapy in neuromyelitis optica spectrum disorder: A randomised, double-blind, multicentre, placebo-controlled phase 3 trial","volume":"19","author":"Traboulsee","year":"2020","journal-title":"Lancet Neurol."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"2114","DOI":"10.1056\/NEJMoa1901747","article-title":"Trial of Satralizumab in Neuromyelitis Optica Spectrum Disorder","volume":"381","author":"Yamamura","year":"2019","journal-title":"N. Engl. J. Med."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"1281","DOI":"10.1212\/WNL.94.15_supplement.1281","article-title":"Safety of satralizumab based on pooled data from phase 3 studies in patients with neuromyelitis optica spectrum disorder","volume":"94","author":"Greenberg","year":"2020","journal-title":"Neurology"},{"key":"ref_57","unstructured":"Greenberg, B.M., de Seze, J., Saiz, A., Yamamura, T., Yeaman, M.R., Marcillat, C., Kou, X., Weber, K., Blondeau, K., and Weinshenker, B.G. (2021, January 13\u201315). Long-term safety of satralizumab in neuromyelitis optica spectrum disorder: Results from the open open-label extension periods of SAkuraSky and SAkuraStar. Proceedings of the ECTRIMS 2021, Vienna, Austria."},{"key":"ref_58","unstructured":"Weinshenker, B.G., Blondeau, K., Kou, X., Marcillat, C., Weber, K., and Greenberg, B.M. (2020, January 11\u201313). Infection rates with satralizumab in patients with neuromyelitis optica spectrum disorder (NMOSD): Results from the phase 3 SAkura studies. Proceedings of the ACTRIMS\/ECTRIMS 2020, Online."},{"key":"ref_59","unstructured":"(2022, March 02). Food and Drug Administration, US ENSPRYNG Product Information, Available online: https:\/\/www.accessdata.fda.gov\/drugsatfda_docs\/label\/2020\/761149s000lbl.pdf."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"1352","DOI":"10.1016\/S0140-6736(19)31817-3","article-title":"Inebilizumab for the treatment of neuromyelitis optica spectrum disorder (N-MOmentum): A double-blind, randomised placebo-controlled phase 2\/3 trial","volume":"394","author":"Cree","year":"2019","journal-title":"Lancet"},{"key":"ref_61","unstructured":"(2022, March 02). Food and Drug Administration, US UPLIZNA Product Information, Available online: https:\/\/www.accessdata.fda.gov\/drugsatfda_docs\/label\/2020\/761142s000lbl.pdf."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"3998","DOI":"10.1212\/WNL.94.15_supplement.3998","article-title":"Long-term Efficacy and Safety of Inebilizumab for Neuromyelitis Optica Spectrum Disorder in the Randomised, Double-blind N-MOmentum Study and Extension","volume":"94","author":"Cree","year":"2020","journal-title":"Neurology"},{"key":"ref_63","doi-asserted-by":"crossref","unstructured":"Rensel, M., Zabeti, A., Mealy, M.A., Cimbora, D., She, D., Drappa, J., and Katz, E. (2021). Long-term efficacy and safety of inebilizumab in neuromyelitis optica spectrum disorder: Analysis of aquaporin-4-immunoglobulin G-seropositive participants taking inebilizumab for \u22654 years in the N-MOmentum trial. Mult. Scler., ahead of print.","DOI":"10.1177\/13524585211047223"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"577790","DOI":"10.1016\/j.jneuroim.2021.577790","article-title":"Evaluation of effect of empirical attack-preventive immunotherapies in neuromyelitis optica spectrum disorders: An update systematic review and meta -analysis","volume":"363","author":"Ma","year":"2022","journal-title":"J. Neuroimmunol."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1007\/s40120-021-00295-8","article-title":"Network Meta-analysis of Food and Drug Administration-approved Treatment Options for Adults with Aquaporin-4 Immunoglobulin G-positive Neuromyelitis Optica Spectrum Disorder","volume":"11","author":"Wingerchuk","year":"2022","journal-title":"Neurol. Ther."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"102166","DOI":"10.1016\/j.msard.2020.102166","article-title":"Efficacy and Safety of Monoclonal Antibody Therapy in Neuromyelitis Optica Spectrum Disorders: Evidence from Randomized Controlled Trials","volume":"43","author":"Xue","year":"2020","journal-title":"Mult. Scler. Relat. Disord."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"2025","DOI":"10.1002\/acn3.51451","article-title":"A meta-analysis comparing first-line immunosuppressants in neuromyelitis optica","volume":"8","author":"Giovannelli","year":"2021","journal-title":"Ann. Clin. Translat. Neurol."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1016\/j.msard.2019.08.009","article-title":"Effectiveness and tolerability of immunosuppressants and monoclonal antibodies in preventive treatment of neuromyelitis optica spectrum disorders: A systematic review and network meta-analysis","volume":"35","author":"Huang","year":"2019","journal-title":"Mult. Scler. Relat. Disord."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"652759","DOI":"10.3389\/fphar.2021.652759","article-title":"Monoclonal Antibody Therapy in Neuromyelitis Optica Spectrum Disorders: A Meta-analysis of Randomized Control Trials","volume":"12","author":"Kong","year":"2021","journal-title":"Front. Pharmacol."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1038\/s41582-020-0313-y","article-title":"Neuromyelitis optica spectrum disorders and pregnancy: Therapeutic considerations","volume":"16","author":"Thiel","year":"2020","journal-title":"Nat. Rev. Neurol."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1002\/ibd.22948","article-title":"Systematic review and meta-analysis on the effects of thiopurines on birth outcomes from female and male patients with inflammatory bowel disease","volume":"19","author":"Akbari","year":"2013","journal-title":"Inflamm. Bowel Dis."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"e913","DOI":"10.1212\/NXI.0000000000000913","article-title":"Anti-CD20 therapies and pregnancy in neuroimmunologic disorders: A cohort study from Germany","volume":"8","author":"Kuempfel","year":"2020","journal-title":"Neurol. Neuroimmunol. Neuroinflamm."}],"container-title":["International Journal of Molecular Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1422-0067\/23\/8\/4154\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:50:53Z","timestamp":1760136653000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1422-0067\/23\/8\/4154"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,4,9]]},"references-count":72,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2022,4]]}},"alternative-id":["ijms23084154"],"URL":"https:\/\/doi.org\/10.3390\/ijms23084154","relation":{},"ISSN":["1422-0067"],"issn-type":[{"value":"1422-0067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,4,9]]}}}