Treatment of NMOSD When Both AQP4-IgG and MOG-IgG Test Negative in Serum

Clinical Scenario

This protocol is for patients with neuromyelitis optica spectrum disorder who are negative for aquaporin-4 immunoglobulin G antibody (AQP4-IgG) and negative for myelin-oligodendrocyte-glycoprotein immunoglobulin G antibody (MOG-IgG) in serum — referred to as double-negative NMOSD. This seronegative subgroup presents distinct management considerations, particularly when initial immunotherapy is not achieving an adequate response.

Treatment Approach

When initial immunotherapy is insufficient in double-negative NMOSD, the protocol defines a structured escalation pathway — involving combination strategies, alternative immunosuppressive agents, or experimental interventions — selected according to which prior therapy failed.

The complete regimen, decision criteria, and sequencing are available in the full structured protocol.