Different Monoclonal Antibodies and Immunosuppressants Administration in Patients with Neuromyelitis Optica Spectrum Disorder: a Bayesian Network Meta-analysis

Overview

Journal J Neurol

Specialty Neurology

Date 2023 Mar 8

PMID 36884069

Authors

Ziqian Yin

Youjia Qiu

Aojie Duan

Ting Fang

Zhouqing Chen

Jiang Wu

Zhong Wang

Gang Chen

Affiliations

Soon will be listed here.

Abstract

Background: A variety of novel monoclonal antibodies and immunosuppressant have been proved effective in treating Neuromyelitis Optica Spectrum Disorder (NMOSD). This network meta-analysis compared and ranked the efficacy and tolerability of currently used monoclonal antibodies and immunosuppressive agents in NMOSD.

Methods: Electronic database including PubMed, Embase and Cochrane Library were searched for relevant studies evaluating monoclonal antibodies and immunosuppressants in patients with NMOSD. The primary outcome measures were annualized relapse rate (ARR), relapse rate, the Expanded Disability Status Scale (EDSS) score, and total adverse events (AEs).

Results: We identified 25 studies with 2919 patients in our meta-analysis. For the primary outcome, rituximab (RTX) (SUCRA: 0.02) ranked first in reduction ARR with a significant difference compared with azathioprine (AZA) (MD - 0.34, 95% CrI - 0.55 to - 0.12) and mycophenolate mofetil (MMF) (MD -0.38, 95% CrI - 0.63 to - 0.14). Tocilizumab (SUCRA: 0.05) ranked first in relapse rate, which was superior to satralizumab (lnOR - 25.4, 95% CrI - 74.4 to - 2.49) and inebilizumab (lnOR - 24.86, 95% CrI - 73.75 to - 1.93). MMF (SUCRA: 0.27) had the fewest AEs followed by RTX (SUCRA: 0.35), both of which showed a significant difference compared with AZA and corticosteroids (MMF vs AZA: lnOR - 1.58, 95% CrI - 2.48 to - 0.68; MMF vs corticosteroids: lnOR - 1.34, 95% CrI - 2.3 to - 0.37) (RTX vs AZA: lnOR - 1.34, 95% CrI - 0.37 to - 2.3; RTX vs corticosteroids: lnOR - 2.52, 95% CrI - 0.32 to - 4.86). In EDSS score, no statistical difference was found between different interventions.

Conclusion: RTX and tocilizumab showed better efficacy than traditional immunosuppressants in reducing relapse. For safety, MMF and RTX had fewer AEs. However, studies with larger sample size on newly developed monoclonal antibodies are warranted in the future.

Citing Articles

A real-world study on the utility of regular rituximab treatment for neuromyelitis optica spectrum disorder.

Chen X, Wang R, Li R, Hu S, Shi Z, Zhou H J Neurol. 2025; 272(3):194.

PMID: 39932569 DOI: 10.1007/s00415-025-12937-0.

Treatment access and satisfaction on disease-modifying therapies of neuromyelitis optica spectrum disorder patients in China: a cross-sectional survey.

Yu Y, Zhong M, Quan C, Ma C Ther Adv Neurol Disord. 2024; 17:17562864241239105.

PMID: 38525489 PMC: 10960978. DOI: 10.1177/17562864241239105.

References

Sellner J, Boggild M, Clanet M, Hintzen R, Illes Z, Montalban X . EFNS guidelines on diagnosis and management of neuromyelitis optica. Eur J Neurol. 2010; 17(8):1019-32. DOI: 10.1111/j.1468-1331.2010.03066.x. View

Watanabe S, Misu T, Miyazawa I, Nakashima I, Shiga Y, Fujihara K . Low-dose corticosteroids reduce relapses in neuromyelitis optica: a retrospective analysis. Mult Scler. 2007; 13(8):968-74. DOI: 10.1177/1352458507077189. View

Ringelstein M, Ayzenberg I, Harmel J, Lauenstein A, Lensch E, Stogbauer F . Long-term Therapy With Interleukin 6 Receptor Blockade in Highly Active Neuromyelitis Optica Spectrum Disorder. JAMA Neurol. 2015; 72(7):756-63. DOI: 10.1001/jamaneurol.2015.0533. View

Jarius S, Wildemann B, Paul F . Neuromyelitis optica: clinical features, immunopathogenesis and treatment. Clin Exp Immunol. 2014; 176(2):149-64. PMC: 3992027. DOI: 10.1111/cei.12271. View

Wingerchuk D, Banwell B, Bennett J, Cabre P, Carroll W, Chitnis T . International consensus diagnostic criteria for neuromyelitis optica spectrum disorders. Neurology. 2015; 85(2):177-89. PMC: 4515040. DOI: 10.1212/WNL.0000000000001729. View

Miyasaka N, Kawai S, Hashimoto H . Efficacy and safety of tacrolimus for lupus nephritis: a placebo-controlled double-blind multicenter study. Mod Rheumatol. 2009; 19(6):606-15. DOI: 10.1007/s10165-009-0218-5. View

Xiao Y, Huang J, Luo H, Wang J . Mycophenolate mofetil for relapsing-remitting multiple sclerosis. Cochrane Database Syst Rev. 2014; (2):CD010242. PMC: 10875409. DOI: 10.1002/14651858.CD010242.pub2. View

Palanichamy A, Jahn S, Nickles D, Derstine M, Abounasr A, Hauser S . Rituximab efficiently depletes increased CD20-expressing T cells in multiple sclerosis patients. J Immunol. 2014; 193(2):580-586. PMC: 4082756. DOI: 10.4049/jimmunol.1400118. View

Mealy M, Wingerchuk D, Palace J, Greenberg B, Levy M . Comparison of relapse and treatment failure rates among patients with neuromyelitis optica: multicenter study of treatment efficacy. JAMA Neurol. 2014; 71(3):324-30. DOI: 10.1001/jamaneurol.2013.5699. View

10.

Elsone L, Kitley J, Luppe S, Lythgoe D, Mutch K, Jacob S . Long-term efficacy, tolerability and retention rate of azathioprine in 103 aquaporin-4 antibody-positive neuromyelitis optica spectrum disorder patients: a multicentre retrospective observational study from the UK. Mult Scler. 2014; 20(11):1533-40. DOI: 10.1177/1352458514525870. View

11.

Qiu W, Kermode A, Li R, Dai Y, Wang Y, Wang J . Azathioprine plus corticosteroid treatment in Chinese patients with neuromyelitis optica. J Clin Neurosci. 2015; 22(7):1178-82. DOI: 10.1016/j.jocn.2015.01.028. View

12.

Araki M, Matsuoka T, Miyamoto K, Kusunoki S, Okamoto T, Murata M . Efficacy of the anti-IL-6 receptor antibody tocilizumab in neuromyelitis optica: a pilot study. Neurology. 2014; 82(15):1302-6. PMC: 4001188. DOI: 10.1212/WNL.0000000000000317. View

13.

Thomas T, Rollins S, Rother R, Giannoni M, Hartman S, Elliott E . Inhibition of complement activity by humanized anti-C5 antibody and single-chain Fv. Mol Immunol. 1996; 33(17-18):1389-401. DOI: 10.1016/s0161-5890(96)00078-8. View

14.

Pittock S, Berthele A, Fujihara K, Kim H, Levy M, Palace J . Eculizumab in Aquaporin-4-Positive Neuromyelitis Optica Spectrum Disorder. N Engl J Med. 2019; 381(7):614-625. DOI: 10.1056/NEJMoa1900866. View

15.

Pittock S, Lucchinetti C . Neuromyelitis optica and the evolving spectrum of autoimmune aquaporin-4 channelopathies: a decade later. Ann N Y Acad Sci. 2015; 1366(1):20-39. PMC: 4675706. DOI: 10.1111/nyas.12794. View

16.

Jiao Y, Fryer J, Lennon V, Jenkins S, Quek A, Smith C . Updated estimate of AQP4-IgG serostatus and disability outcome in neuromyelitis optica. Neurology. 2013; 81(14):1197-204. PMC: 3795610. DOI: 10.1212/WNL.0b013e3182a6cb5c. View

17.

Dai D, Wang Y, Jin H, Mao Y, Sun H . The efficacy of mycophenolate mofetil in treating Takayasu arteritis: a systematic review and meta-analysis. Rheumatol Int. 2017; 37(7):1083-1088. PMC: 5486790. DOI: 10.1007/s00296-017-3704-7. View

18.

Sakairi T, Nakasatomi M, Watanabe M, Hamatani H, Ikeuchi H, Kaneko Y . Primary central nervous system lymphoma in a patient with neuropsychiatric systemic lupus erythematosus receiving mycophenolate mofetil: A case report and literature review. Mod Rheumatol Case Rep. 2021; 6(1):36-40. DOI: 10.1093/mrcr/rxab012. View

19.

Kang S, Tanaka T, Narazaki M, Kishimoto T . Targeting Interleukin-6 Signaling in Clinic. Immunity. 2019; 50(4):1007-1023. DOI: 10.1016/j.immuni.2019.03.026. View

20.

Liberati A, Altman D, Tetzlaff J, Mulrow C, Gotzsche P, Ioannidis J . The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009; 339:b2700. PMC: 2714672. DOI: 10.1136/bmj.b2700. View