Transition to inebilizumab treatment linked to suppression of NMOSD attacks
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Key takeaways:
- A chart review included 14 adults with NMOSD who switched from rituximab to inebilizumab.
- No attacks were observed during inebilizumab treatment over a mean period of 19.3months.
In patients with neuromyelitis optica spectrum disorder, transition from rituximab to inebilizumab was linked to suppression of attacks over a mean 19 months of treatment, according to research published in Frontiers in Neurology.
“Although we have three new FDA approved therapies to prevent relapses, many people with [neuromyelitis optica spectrum disorder] remain on off-label rituximab infusions which were widely used prior to the approved treatments,” Michael Levy, MD, PhD, study co-author and an associate professor of neurology at Harvard Medical School, told Healio in an email.
While treatment with rituximab, which targets CD20-positive B-cells, is used as an off-label therapy for NMOSD, some patients continue to exhibit breakthrough attacks and/or adverse reactions. As information is scarce regarding safety and efficacy of inebilizumab, an FDA-approved humanized and glycoengineered monoclonal antibody targeting CD19-positive B cells for adults who are anti-aquaporin-4 (AQP4) antibody positive, Levy and colleagues conducted a retrospective chart review of those who transitioned from rituximab to inebilizumab.
Their study included 14 adult individuals with NMOSD (mean age at symptom onset, 37.8 years; 78.6% female) who transitioned medications and had a record of at least one dose of inebilizumab.
Outcome measures for the study included changes in NMOSD attack rate, change in Expanded Disability Status Scale (EDSS) score, along with adverse events that accompanied medication switch.
Thirteen of the 14 patients were AQP4 seropositive, while 71.4% (n = 10) experienced a combined 17 attacks during rituximab treatment, attributed to either breakthrough disease (n = 10) or treatment delay (n = 7).
According to results, mean duration of rituximab treatment was 38.4 months (3.2 years). Levy and colleagues found that no subsequent attacks were observed during inebilizumab treatment [mean treatment duration, 19.3 months (1.6years)], underscoring its potential as an effective treatment for NMOSD.
Data suggested that inebilizumab provides clinical benefit with effective disease control and a favorable safety profile for patients transitioning from rituximab.
“At least preliminarily the data support the finding from the trial that inebilizumab can work to prevent relapses in NMOSD, even if rituximab had previously failed,” Levy told Healio. “This suggests that inebilizumab has a broader effect, either by acting on those additional cells, or perhaps by deeper B cell depletion.”