Introduction and objective:
Neuromyelitis optica spectrum disorder (NMOSD) is a rare autoimmune demyelinating disease of the central nervous system, distinct from multiple sclerosis. Its pathogenesis is primarily associated with anti-AQP4-IgG antibodies, though some patients present with anti-MOG-IgG. The most common symptoms include optic neuritis and longitudinal extensive transverse myelitis (LETM) often leading to blindness and tetra- or paraparesis. This review summarizes current and emerging treatment strategies for NMOSD, including therapies used in acute attacks, long-term immunosuppression, and targeted biological agents.

Review methods:
The paper is based on a review of current literature and clinical trial data carried out in March 2025 using electronic databases: PubMed, Scopus and Web of Science. It discusses conventional immunosuppressants (e.g., azathioprine, mycophenolate mofetil, rituximab), targeted therapies (satralizumab, eculizumab, inebilizumab), and the latest Polish drug programme (B.138.FM). Differential diagnostics of NMOSD and radiological imaging of patients is shown.

Brief description of the state of knowledge:
Biologic therapies show significant effectiveness in relapse prevention, especially in AQP4-IgG-positive patients. Satralizumab and inebilizumab reduce relapse rates and disability progression, with favourable safety profiles. Eculizumab provides rapid and sustained complement inhibition, offering high efficacy. Satralizumab is now reimbursed in Poland for eligible patients.

Summary:
Modern, targeted therapies for NMOSD greatly improve patient outcomes and quality of life. Accurate and timely diagnosis, access to appropriate treatment, and individualized therapeutic approaches remain key to reducing long-term disability in NMOSD.