Rituximab (melphalan) is increasingly being used in disease modifying therapy (DMT) for optic neuromyelitis optica (NMO) and its spectrum disorders (NMOSD). It can immediately delete all B cells from the patient’s peripheral blood, reduce plasma cell precursors expressing pathogenic antibodies, and block T-B cell interactions, making it the ultimate tool for blocking NMO attacks. However, we can still observe that a small percentage of refractory NMO, even with meloval, fails to suppress disease recurrence. We have even encountered cases of flare-ups the day after Meroval treatment. Where does the treatment of optic neuromyelitis optica go when Meroval is ineffective? Recently, researchers at the University Hospital Düsseldorf and the St. Josef Hospital of the Ruhr-University Bochum in Germany published their latest findings. The study found that tocilizumab, an interleukin-6 receptor blocker, may be a new way forward for NMO patients with highly active disease who have failed to respond to melphalan and other traditional immunosuppressive agents. Previous studies have demonstrated that IL-6 promotes the synthesis of AQP4 antibodies in plasma cells and that the levels of IL-6 in the cerebrospinal fluid of NMO patients are significantly higher than those of multiple sclerosis patients. It is suggested that IL-6 plays an important role in the pathogenesis of NMO. 6-8 mg/kg tocilizumab, treated every 4-6 weeks, was observed for a mean of 30.9 months. Subjects’ annualized relapse rate (ARR) decreased from 4.0 pre-treatment to 0.4 post-treatment; EDSS scores decreased from 7.3 to 5.5; tocilizumab treatment resulted in a significant reduction in neurologically active enhancing lesions and a significant reduction in AQP4 antibody titers and limb pain scores in all subjects compared to pre-treatment. This is the largest number of cases and longest observation period study to date, and all subjects were NMO patients who were not responding to meloval therapy. The study was published in the May 2015 issue of JAMA Neurol.