Recent progress in maintenance treatment of neuromyelitis optica spectrum disorder

Trygve Holmøy; Rune Alexander Høglund; Zsolt Illes; Kjell Morten Myhr; Øivind Torkildsen

doi:10.1007/s00415-020-10235-5

Recent progress in maintenance treatment of neuromyelitis optica spectrum disorder

Trygve Holmøy^*
, Rune Alexander Høglund
, Zsolt Illes
, Kjell Morten Myhr
, Øivind Torkildsen

^*Kontaktforfatter

KI, OUH, Forskningsenhed for Neurologi (Odense)

Akershus University Hospital
University of Oslo
University of Bergen
Haukeland University Hospital

Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › peer review

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Abstract

Background: Treatment of neuromyelitis optica spectrum disorder (NMOSD) has so far been based on retrospective case series. The results of six randomized clinical trials including five different monoclonal antibodies targeting four molecules and three distinct pathophysiological pathways have recently been published. Methods: Literature search on clinical trials and case studies in NMOSD up to July 10. 2020. Results: We review mechanism of action, efficacy and side effects, and consequences for reproductive health from traditional immunosuppressants and monoclonal antibodies including rituximab, inebilizumab, eculizumab, tocilizumab and satralizumab. Conclusion: In NMOSD patients with antibodies against aquaporin 4, monoclonal antibodies that deplete B cells (rituximab and inebilizumab) or interfere with interleukin 6 signaling (tocilizumab and satralizumab) or complement activation (eculizumab) have superior efficacy compared to placebo. Tocilizumab and rituximab were also superior to azathioprine in head-to-head studies. Rituximab, tocilizumab and to some extent eculizumab have well-known safety profiles for other inflammatory diseases, and rituximab and azathioprine may be safe during pregnancy.

Originalsprog	Engelsk
Tidsskrift	Journal of Neurology
Vol/bind	268
Udgave nummer	12
Sider (fra-til)	4522-4536
ISSN	0340-5354
DOI	https://doi.org/10.1007/s00415-020-10235-5
Status	Udgivet - dec. 2021

Finansiering

Open Access funding provided by University of Oslo (incl Oslo University Hospital). No targeted funding was received for this work. KMM and ØT are funded by Norwegian Research Council Grant #288164 (Neuro-SysMed). Trygve Holmøy has received speakers’ honoraria and/or unrestricted research grants from Biogen, Roche, Sanofi and Merck, and has been principal investigator in studies sponsored by Biogen, Merck and Roche. Rune A. Høglund has received speakers’ honoraria and/or unrestricted grants from Biogen, Merck, Roche and Novartis, and participated as investigator in study sponsored by Roche. Zsolt Illes has received speakers’ honoraria and/or research grants from Biogen, Roche, Sanofi, Novartis and Merck, has been member of advisory boards at Alexion, Biogen, Sanofi, Merck, Roche, Novartis, was member of the adjudication relapse committee in the SAkuraStar and SAkuraSky trials, and has been principal investigator in studies sponsored by Biogen, Merck and Sanofi. Øivind Torkildsen has received speakers’ honoraria and/or unrestricted research grants from Biogen, Roche, Novartis, Merck and Sanofi and has been principal investigator in studies sponsored by Sanofi. Kjell-Morten Myhr has received unrestricted research grants to his institution; scientific advisory board, and speakers’ honoraria from Almirall, Biogen, Genzyme, Merck, Novartis, Roche, or Teva; and has participated in clinical trials organized by Biogen, Merck, Novartis, or Roche.

Dokumenter og links

10.1007/s00415-020-10235-5Licens: CC BY

Open Access VersionForlagets udgivne version, 1,32 MBLicens: CC BY

SDU link

Tjek adgangen til materialet i Syddansk Universitetsbiblioteks søgemaskine

Citationsformater

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abstract = "Background: Treatment of neuromyelitis optica spectrum disorder (NMOSD) has so far been based on retrospective case series. The results of six randomized clinical trials including five different monoclonal antibodies targeting four molecules and three distinct pathophysiological pathways have recently been published. Methods: Literature search on clinical trials and case studies in NMOSD up to July 10. 2020. Results: We review mechanism of action, efficacy and side effects, and consequences for reproductive health from traditional immunosuppressants and monoclonal antibodies including rituximab, inebilizumab, eculizumab, tocilizumab and satralizumab. Conclusion: In NMOSD patients with antibodies against aquaporin 4, monoclonal antibodies that deplete B cells (rituximab and inebilizumab) or interfere with interleukin 6 signaling (tocilizumab and satralizumab) or complement activation (eculizumab) have superior efficacy compared to placebo. Tocilizumab and rituximab were also superior to azathioprine in head-to-head studies. Rituximab, tocilizumab and to some extent eculizumab have well-known safety profiles for other inflammatory diseases, and rituximab and azathioprine may be safe during pregnancy.",

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doi = "10.1007/s00415-020-10235-5",

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AU - Holmøy, Trygve

AU - Høglund, Rune Alexander

AU - Illes, Zsolt

AU - Myhr, Kjell Morten

AU - Torkildsen, Øivind

PY - 2021/12

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N2 - Background: Treatment of neuromyelitis optica spectrum disorder (NMOSD) has so far been based on retrospective case series. The results of six randomized clinical trials including five different monoclonal antibodies targeting four molecules and three distinct pathophysiological pathways have recently been published. Methods: Literature search on clinical trials and case studies in NMOSD up to July 10. 2020. Results: We review mechanism of action, efficacy and side effects, and consequences for reproductive health from traditional immunosuppressants and monoclonal antibodies including rituximab, inebilizumab, eculizumab, tocilizumab and satralizumab. Conclusion: In NMOSD patients with antibodies against aquaporin 4, monoclonal antibodies that deplete B cells (rituximab and inebilizumab) or interfere with interleukin 6 signaling (tocilizumab and satralizumab) or complement activation (eculizumab) have superior efficacy compared to placebo. Tocilizumab and rituximab were also superior to azathioprine in head-to-head studies. Rituximab, tocilizumab and to some extent eculizumab have well-known safety profiles for other inflammatory diseases, and rituximab and azathioprine may be safe during pregnancy.

AB - Background: Treatment of neuromyelitis optica spectrum disorder (NMOSD) has so far been based on retrospective case series. The results of six randomized clinical trials including five different monoclonal antibodies targeting four molecules and three distinct pathophysiological pathways have recently been published. Methods: Literature search on clinical trials and case studies in NMOSD up to July 10. 2020. Results: We review mechanism of action, efficacy and side effects, and consequences for reproductive health from traditional immunosuppressants and monoclonal antibodies including rituximab, inebilizumab, eculizumab, tocilizumab and satralizumab. Conclusion: In NMOSD patients with antibodies against aquaporin 4, monoclonal antibodies that deplete B cells (rituximab and inebilizumab) or interfere with interleukin 6 signaling (tocilizumab and satralizumab) or complement activation (eculizumab) have superior efficacy compared to placebo. Tocilizumab and rituximab were also superior to azathioprine in head-to-head studies. Rituximab, tocilizumab and to some extent eculizumab have well-known safety profiles for other inflammatory diseases, and rituximab and azathioprine may be safe during pregnancy.

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KW - Monoclonal antibodies

KW - Neuromyelitis optica spectrum disorder

KW - Treatment

KW - Aquaporin 4

KW - Neuromyelitis Optica/drug therapy

KW - Antibodies, Monoclonal, Humanized

KW - Humans

KW - Retrospective Studies

KW - Rituximab/therapeutic use

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DO - 10.1007/s00415-020-10235-5

M3 - Journal article

C2 - 33011853

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SN - 0340-5354

VL - 268

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EP - 4536

JO - Journal of Neurology

JF - Journal of Neurology

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ER -

Recent progress in maintenance treatment of neuromyelitis optica spectrum disorder

Abstract

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