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Inebilizumab, a newly approved medication for NMOSD, is determined to be effective at limiting relapses. However, there are some limitations regarding which patients may benefit.

Among patients with neuromyelitis optica spectrum disorder (NMOSD), a significant percentage are anti-aquaporin-4 (AQP4) antibody seropositive. Inebilizumab is a monoclonal antibody treatment that targets the B cell antigen CD19 in order to deplete B cells and thereby reduce inflammatory NMOSD attacks, which can often be disabling or life-threatening. This study, published in CNS Drugs, analyzed the efficacy of inebilizumab as a treatment for NMOSD.

The efficacy of inebilizumab was evaluated on the basis of a double-blind, placebo-controlled study. All participants were 18 years of age or older, diagnosed with NMOSD, and had an expanded disability status score of 8 or less. Participants had also all had one or more documented NMOSD attacks that needed rescue therapy. Both AQP4-antibody seropositive and seronegative patients were enrolled in the study, but seronegative patients had to meet additional criteria in order to avoid NMOSD misdiagnosis.

Inebilizumab was found to significantly increase the time to onset of NMOSD attacks, and the rate of NMOSD attacks among those taking inebilizumab significantly decreased during the trial period. This efficacy extended to both seropositive and seronegative groups.

The authors note that they could not determine if inebilizumab was effective in the AQP4-antibody seronegative subgroup because of the small number enrolled, despite the apparent efficacy in the data. However, the efficacy of inebilizumab was consistent regardless of attack location between the optic nerve and spinal cord. Efficacy also extended across a range of demographic and baseline characteristics, and did not vary with respect to whether patients had received rituximab treatment in the past. The authors conclude that the data support inebilizumab as an effective treatment option for preventing NMOSD relapses in AQP4-antibody seropositive adults.

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Reference
Nie, T., & Blair, H. A. (2022). Inebilizumab: A Review in Neuromyelitis Optica Spectrum Disorder. CNS Drugs, 36(10), 1133-1141. doi:10.1007/s40263-022-00949-7