Modern Approaches to the Treatment of the Disease Spectrum Optic Neuromyelitis: Analysis of Clinical Practice and Conditions in the Kyrgyz Republic

Neuromyelitis optica spectrum disorders (NMOSD) are rare but clinically significant demyelinating diseases whose primary pathogenetic mechanism is humoral-mediated immune inflammation, with antibodies to aquaporin-4 (AQP4-IgG) playing a leading role. This determines a unique clinical picture and a high risk of severe, irreversible neurological disorders in the absence of timely treatment. Advances in understanding the pathogenesis of NMOSD have significantly revised diagnostic criteria and approaches to managing this patient population. However, implementing targeted approaches in resource-limited countries remains challenging and requires adapting international protocols to local healthcare capabilities, a task of particular relevance in the context of the Kyrgyz Republic. The aim of this study was to summarize clinical experience with NMOSD treatment in the Kyrgyz Republic and determine the feasibility of targeted therapy. The primary focus of therapy in the acute phase is the rapid suppression of immune inflammation and minimization of damage to the central nervous system. The standard of care is high-dose pulse glucocorticosteroid therapy, followed by plasmapheresis therapy in the absence of clinical improvement, and in some cases, immunoglobulin therapy. Rituximab is already used as the most accessible biological agent for the long-term prevention of relapses, while azathioprine retains a key role due to its availability and accumulated experience. Proper selection of medications, taking into account serological profile parameters, severity and frequency of exacerbations, and the presence of comorbidities, allows for an assessment of potential risks and the quality of therapy. Barriers to optimizing care remain the limited availability of serodiagnostics (AQP4/MOG), the limited pool of registered targeted agents, and economic constraints on their widespread use.