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Receiving an Neuromyelitis Optica Spectrum Disorder (NMOSD) diagnosis is life-altering, and it is completely understandable to feel overwhelmed. NMOSD is rare, it is often misdiagnosed before it is caught, and finding a treatment center with real experience in this disease can be difficult. If your neurologist has prescribed infusion therapy, you need a center that understands the condition and coordinates closely with your care team.
At Althea Infusion, we administer FDA-approved NMOSD infusion therapies as prescribed by your neurologist, including Uplizna and Soliris. We serve patients in a comfortable outpatient setting with direct coordination with your specialist.
Here is what you need to know about NMOSD infusion treatment, how each therapy works, and what to expect at your appointment.
What Is Neuromyelitis Optica Spectrum Disorder (NMOSD)?
NMOSD is a rare autoimmune disease in which the immune system mistakenly attacks the central nervous system – primarily the optic nerves and spinal cord. This causes episodes of inflammation that can lead to vision loss, weakness, paralysis, and loss of bladder or bowel control depending on where the attack occurs.
In most NMOSD patients, attacks are driven by antibodies against aquaporin-4 (AQP4), a protein found on cells in the brain and spinal cord. A smaller subset of patients test positive for antibodies against myelin oligodendrocyte glycoprotein (MOG-IgG), a related but distinct condition sometimes called MOGAD.
Unlike Multiple Sclerosis, NMOSD does not typically cause gradual progression between attacks – but attacks themselves can be severe and cause lasting disability. This is why preventing attacks through long-term maintenance therapy is the primary goal of treatment.
How NMOSD Infusion Therapy Works
FDA-approved NMOSD therapies work by targeting specific parts of the immune system responsible for the attacks that damage the optic nerves and spinal cord. These are not general immune suppressants – they are precision biologics designed to interrupt the specific pathways driving NMOSD inflammation.
The goal of long-term infusion therapy in NMOSD is attack prevention. Each attack carries the risk of permanent neurological damage, so maintaining consistent treatment on the prescribed schedule is critical. Your neurologist will determine the appropriate therapy based on your antibody status, attack history, and overall health.
FDA-Approved NMOSD Infusion Treatments We Administer
Uplizna (Inebilizumab)
Uplizna is an anti-CD19 monoclonal antibody that targets and depletes B cells and plasmablasts – the immune cells responsible for producing the AQP4 antibodies that drive NMOSD attacks. By reducing these cells, Uplizna significantly lowers the risk of relapse.
FDA approval: Approved for adults with AQP4-IgG seropositive NMOSD.
Dosing: 300mg IV on Day 1 and Day 15 as loading doses, followed by 300mg every six months.
Infusion time: Approximately 90 minutes per infusion, administered in a monitored outpatient setting.
Monitoring: Hepatitis B screening required before starting. B cell counts and immunoglobulin levels monitored over time. Vaccinations should be up to date before initiation.
Best for: AQP4-IgG seropositive NMOSD patients seeking a twice-yearly maintenance schedule with strong attack prevention data.
Soliris (Eculizumab)
Soliris is a complement inhibitor – it works by blocking complement protein C5, a key component of the immune cascade that causes the inflammatory damage seen in NMOSD attacks. Rather than depleting B cells, Soliris interrupts the downstream inflammatory process triggered by AQP4 antibodies.
FDA approval: Approved for adults with AQP4-IgG seropositive NMOSD.
Dosing: 900mg weekly for four weeks as induction, followed by 1200mg every two weeks as maintenance.
Infusion time: Approximately 35 minutes per infusion, though the frequent dosing schedule means more regular visits than other NMOSD therapies.
Important: Soliris significantly increases the risk of meningococcal infection – a potentially life-threatening bacterial infection. Meningococcal vaccination is required before starting therapy and must be kept current throughout treatment. Your neurologist will review this requirement before prescribing.
Best for: AQP4-IgG seropositive NMOSD patients who need a different mechanism of action from B cell-depleting therapies, or who have not responded adequately to other treatments.
Ultomiris (Ravulizumab)
Ultomiris is a next-generation complement inhibitor developed from the same mechanism as Soliris – it also blocks complement protein C5 to prevent the inflammatory cascade that damages the optic nerves and spinal cord in NMOSD. The key difference is its significantly longer half-life, which allows for less frequent dosing. For patients who require complement inhibition, Ultomiris offers the same mechanism with a more convenient schedule.
FDA approval: Approved for adults with AQP4-IgG seropositive NMOSD.
Dosing: Weight-based induction doses followed by maintenance infusions every eight weeks – significantly less frequent than Soliris’s every-two-week schedule.
Infusion time: Approximately 45 minutes to one hour per infusion depending on weight-based dosing.
Important: Like Soliris, Ultomiris carries a significant risk of meningococcal infection due to complement inhibition. Meningococcal vaccination is mandatory before starting therapy and must be maintained throughout treatment. Your neurologist will confirm vaccination status before prescribing.
Best for: AQP4-IgG seropositive NMOSD patients who need complement inhibition and prefer a less frequent dosing schedule than Soliris. Many neurologists now prescribe Ultomiris over Soliris for new patients due to the every-eight-week convenience.
IVIG in Certain NMOSD Situations
Intravenous immunoglobulin (IVIG) is not a primary maintenance therapy for most NMOSD patients, but it may be used in specific clinical situations – for example, during pregnancy when other NMOSD therapies carry fetal risk, or as a bridge therapy when transitioning between treatments.
Use of IVIG in NMOSD is determined by your neurologist based on your individual circumstances. If your neurologist has prescribed IVIG as part of your NMOSD management, our team can administer it in our outpatient setting.
A Note on Seronegative NMOSD
Approximately 20 to 30 percent of NMOSD patients test negative for both AQP4-IgG and MOG-IgG antibodies. This is referred to as seronegative NMOSD. The FDA-approved biologics covered above – Uplizna, Soliris, and Ultomiris – are specifically approved for AQP4-IgG seropositive patients and are not indicated for seronegative disease.
For seronegative NMOSD patients, neurologists often turn to Rituximab (Rituxan) as an off-label treatment option. Rituximab is a B cell-depleting anti-CD20 therapy that has been used in NMOSD for many years and has a substantial body of clinical evidence supporting its use in both seropositive and seronegative patients, despite not carrying a specific FDA approval for NMOSD.
Rituximab (Rituxan) for Seronegative NMOSD
Approval status: Off-label for NMOSD. Rituximab is FDA-approved for other conditions including certain lymphomas, rheumatoid arthritis, and other autoimmune diseases. Its use in NMOSD is supported by clinical evidence and expert consensus but does not carry an NMOSD-specific FDA indication.
Mechanism: Rituximab targets CD20-positive B cells and depletes them, reducing the production of pathogenic antibodies involved in NMOSD attacks. The effect is similar in principle to Uplizna but through a different target antigen.
Dosing: Dosing schedules vary. Common approaches include 1000mg given twice two weeks apart and repeated every six months, or 375mg per square meter weekly for four doses. Your neurologist will prescribe the specific schedule appropriate for your case.
Infusion time: Typically three to five hours per infusion, particularly for the first dose which is administered slowly to monitor for infusion reactions. Subsequent infusions may be given at a faster rate if the first was well tolerated.
Monitoring: Hepatitis B screening required before starting. B cell counts and immunoglobulin levels monitored over time. Increased infection risk due to B cell depletion. Live vaccines should not be given during treatment.
Best for: Seronegative NMOSD patients whose neurologist has determined Rituximab is the appropriate off-label maintenance option, as well as certain seropositive patients where Rituximab may be used based on clinical history and neurologist preference.
Acute Attack Treatment vs. Long-Term Maintenance
It is important to understand the difference between treating an active NMOSD attack and preventing future attacks.
Acute attack treatment – When an NMOSD attack occurs, high-dose intravenous corticosteroids are typically the first line of treatment to reduce inflammation and limit damage. Plasma exchange (plasmapheresis) may be used if steroids do not achieve adequate response. Acute treatment is generally administered in a hospital or specialized setting.
Long-term maintenance therapy – FDA-approved biologics like Uplizna and Soliris are maintenance therapies designed to prevent future attacks. They are not used to treat an attack in progress. Maintenance therapy is administered on a scheduled basis in an outpatient infusion center.
Given how severe NMOSD attacks can be, consistent adherence to your maintenance therapy schedule is one of the most important things you can do to protect your long-term neurological function.
Who Should Consider NMOSD Infusion Therapy?
NMOSD infusion therapy may be appropriate for patients who are:
- Diagnosed with AQP4-IgG seropositive NMOSD and starting a long-term prevention strategy
- Experiencing relapses on their current therapy and being switched to a different biologic
- Newly diagnosed and initiating maintenance therapy for the first time
- Transitioning from one NMOSD therapy to another and need careful coordination
- Looking for an outpatient infusion center experienced in rare neurological conditions
- Switching infusion centers and need seamless continuity of their current therapy
NMOSD therapy is prescribed and directed by your neurologist. Our role is to administer that therapy safely, monitor you throughout each session, and maintain clear communication with your care team.
Side Effects and Safety Monitoring
Side effect profiles differ by medication. All NMOSD infusion therapies at Althea are administered in a monitored clinical setting with a nurse present throughout every session.
Common infusion-related reactions – generally mild and manageable:
- Headache, fatigue, or mild fever
- Nausea or mild gastrointestinal discomfort
- Flushing or skin reactions during infusion
- Temporary changes in blood pressure
Medication-specific risks requiring ongoing monitoring:
- Uplizna – increased infection risk due to B cell depletion; hepatitis B screening required before starting; immunoglobulin levels monitored over time; vaccinations should be current before initiation
- Soliris and Ultomiris – significantly increased risk of meningococcal infection due to complement inhibition; meningococcal vaccination required before starting and must be maintained throughout treatment; patients should carry a safety card and seek immediate care for signs of meningococcal disease
Our nurses monitor you throughout every session and communicate directly with your neurologist so that any safety concerns are addressed promptly.
What to Expect at Your Althea NMOSD Infusion Appointment
Appointment length varies by medication. Uplizna infusions take approximately 90 minutes and are given every six months. Soliris infusions take approximately 35 minutes but are given every two weeks. Ultomiris infusions take approximately 45 minutes to one hour and are given every eight weeks. Your neurologist’s orders will specify the schedule for your specific therapy.
Before Your First Visit
Our team contacts your neurologist to obtain orders, verifies your insurance benefits, completes prior authorization, and confirms all required lab results and vaccination records are on file. For Soliris specifically, we confirm meningococcal vaccination status before scheduling your first infusion.
At Check-In
We review your neurologist’s orders, confirm your current labs, and complete a brief clinical assessment before your infusion begins. Vital signs are taken and any previous reactions are noted.
During Your Infusion
Your IV is placed by an experienced infusion nurse and you are monitored throughout the session. Our environment is calm and low-key – bring something to read or headphones. Given the relative rarity of NMOSD, we make a point of ensuring our nursing staff is familiar with the specific monitoring requirements for each therapy.
Before Discharge
After your infusion we complete an observation period, assess how you are feeling, and send a clinical summary to your neurologist. We schedule your next appointment before you leave so your maintenance schedule stays on track.
Insurance Coverage and Cost of NMOSD Infusion Therapy
Most major insurance plans cover FDA-approved NMOSD infusion therapies when prescribed by a neurologist and prior authorization requirements are met. Uplizna, Soliris, and Ultomiris are all high-cost biologics, and out-of-pocket cost varies significantly by plan. Coverage for Rituximab in seronegative NMOSD varies by payer and requires strong clinical documentation to support the off-label use.
Manufacturer patient assistance programs are available for Uplizna, Soliris, and Ultomiris and may significantly reduce or eliminate patient cost-sharing for eligible patients. Rituximab patient assistance options vary by manufacturer program and clinical indication.
Our team verifies your benefits, completes prior authorization, and researches available patient assistance programs to help minimize your out-of-pocket costs before your first appointment – so there are no billing surprises on infusion day.
Frequently Asked Questions About NMOSD Infusion Therapy
What is the difference between NMOSD and Multiple Sclerosis (MS)?
NMOSD and Multiple Sclerosis (MS) are both autoimmune diseases that affect the central nervous system, but they are driven by different immune mechanisms and require different treatments. NMOSD is primarily caused by AQP4 antibodies attacking the optic nerves and spinal cord, while MS involves a broader immune attack on myelin throughout the brain and spinal cord. MS treatments like Ocrevus and Tysabri are not appropriate for AQP4-positive NMOSD and can sometimes worsen the condition. An accurate diagnosis and antibody testing are essential before starting any therapy.
How long does an Uplizna infusion take?
Uplizna infusions take approximately 90 minutes and are given every six months after the initial two loading doses. The twice-yearly schedule makes it one of the more convenient maintenance options for NMOSD patients.
Why do Soliris and Ultomiris require a meningococcal vaccine?
Both Soliris and Ultomiris block complement protein C5, which is part of the immune system’s defense against encapsulated bacteria including Neisseria meningitidis – the bacteria that causes meningococcal disease. Without complement function, patients on either therapy are at significantly higher risk of this infection, which can be life-threatening. Vaccination before starting therapy and ongoing vaccination boosters are mandatory. Your neurologist will confirm vaccination status before prescribing either medication.
What is the difference between Soliris and Ultomiris?
Both work by the same mechanism – blocking complement C5 – and both are approved for AQP4-IgG seropositive NMOSD. The primary difference is dosing frequency. Soliris is given every two weeks during maintenance, while Ultomiris is given every eight weeks. Many neurologists now prefer Ultomiris for new patients because the less frequent schedule reduces the burden of regular infusion visits while maintaining the same mechanism of protection. Your neurologist will determine which is appropriate based on your clinical history and preferences.
Can I receive NMOSD infusion therapy if I am pregnant or planning to become pregnant?
This is an important question to discuss with your neurologist before starting or continuing any NMOSD biologic therapy. Some therapies carry fetal risk and may need to be paused or substituted during pregnancy. IVIG has been used in some pregnant NMOSD patients as an alternative. Your neurologist and OB should coordinate on your treatment plan if pregnancy is a consideration.
Does insurance cover NMOSD infusion therapy?
Most major plans cover FDA-approved NMOSD therapies when medically necessary and prescribed by a neurologist. Prior authorization is typically required and may require documentation of AQP4 antibody status and attack history. Our team handles benefits verification and prior authorization before your first appointment, and we research patient assistance programs to minimize your out-of-pocket costs.
I tested negative for AQP4 and MOG antibodies. Can Althea still treat me?
Yes, in many cases. Seronegative NMOSD patients are often prescribed Rituximab off-label as a maintenance therapy, and Althea can administer Rituximab when prescribed by your neurologist. Coverage for off-label Rituximab in seronegative NMOSD varies by insurance plan and requires clinical documentation, which our team will help coordinate during the prior authorization process. Contact us with your neurologist’s information and we will confirm whether we can support your specific treatment plan.
How do I get started with NMOSD infusion therapy at Althea?
Contact us with your neurologist’s information and the name of your prescribed therapy. We will reach out to your neurologist to obtain orders, verify your insurance, confirm required labs and vaccinations, and schedule your first appointment. You do not need a separate referral to contact us directly.
Schedule Your NMOSD Infusion Appointment
If you are looking for an outpatient NMOSD infusion center near you, Althea Infusion works directly with your neurologist to administer prescribed therapy, coordinate scheduling, and handle insurance benefits on your behalf.
Contact us today to get started or to ask questions about your treatment options.📞 Call us: (949) 667-4325 (HEAL)
