Journal
JOURNAL OF NEUROLOGY
Volume 268, Issue 12, Pages 4522-4536Publisher
SPRINGER HEIDELBERG
DOI: 10.1007/s00415-020-10235-5
Keywords
Neuromyelitis optica spectrum disorder; Demyelinating diseases; Treatment; Monoclonal antibodies
Categories
Funding
- University of Oslo (Oslo University Hospital)
- Norwegian Research Council Grant [288164]
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For NMOSD patients, monoclonal antibodies that deplete B cells or interfere with interleukin 6 signaling have superior efficacy compared to placebo; Rituximab, tocilizumab, and to some extent eculizumab have well-known safety profiles; Rituximab and azathioprine may be safe during pregnancy.
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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