High-efficacy therapies reduce clinical and radiological events more effectively than traditional treatments in neuromyelitis optica spectrum disorder

Moog, Tatum M.; Smith, Alexander D.; Burgess, Katy W; McCreary, Morgan; Okuda, Darin T.

doi:10.1007/s00415-023-11710-5

Cited by 4 publications

(4 citation statements)

References 26 publications

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“…Thus, the relapsing nature of the disease together with the importance of a patient-centered approach with shared decision-making should lead to a shift in the treatment paradigm to early use of high-efficacy therapies when treating this condition, as it is evolving in the MS field ( 42 ). This is a matter of importance in NMOSD due to the severity of relapses, poor recovery, and associated disability accumulation ( 5 , 22 , 39 , 43 ). New therapeutic landscapes might facilitate reaching this ambition, as recent studies have shown an increase in the use of high-efficacy monoclonal antibodies with better outcomes at the expense of IST/OCs ( 7 , 22 , 44 ).…”

Section: Discussionmentioning

confidence: 99%

“…This is a matter of importance in NMOSD due to the severity of relapses, poor recovery, and associated disability accumulation ( 5 , 22 , 39 , 43 ). New therapeutic landscapes might facilitate reaching this ambition, as recent studies have shown an increase in the use of high-efficacy monoclonal antibodies with better outcomes at the expense of IST/OCs ( 7 , 22 , 44 ). However, as shown in this study, there is still a need to improve therapeutic decisions in order to reduce the prevalence of TI and its magnitude, as new highly effective therapies may be an advantage, but the choice between multiple options might lead to suboptimal decisions.…”

Section: Discussionmentioning

confidence: 99%

“…For the same reason, we established the term therapeutic error (TE) for case scenarios where, despite evidence of disease activity, the decision was to deescalate to a lower efficacy treatment (cases 3 and 4). In our study, high-efficacy treatments were considered those having more than 70% of efficacy in reduction of risk of new relapses ( 22 ), that is, Drugs C- F in Table 1 .…”

Section: Methodsmentioning

confidence: 99%

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Therapeutic inertia in the management of neuromyelitis optica spectrum disorder

Cobo-Calvo,

Gómez-Ballesteros,

Orviz

et al. 2024

Front. Neurol.

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Introduction and objectiveLimited information is available on how neurologists make therapeutic decisions in neuromyelitis optica spectrum disorder (NMOSD), especially when new treatments with different mechanisms of action, administration, and safety profile are being approved. Decision-making can be complex under this uncertainty and may lead to therapeutic inertia (TI), which refers to lack of treatment initiation or intensification when therapeutic goals are not met. The study aim was to assess neurologists’ TI in NMOSD.MethodsAn online, cross-sectional study was conducted in collaboration with the Spanish Society of Neurology. Neurologists answered a survey composed of demographic characteristics, professional background, and behavioral traits. TI was defined as the lack of initiation or intensification with high-efficacy treatments when there is evidence of disease activity and was assessed through five NMOSD aquaporin-4 positive (AQP4+) simulated case scenarios. A multivariate logistic regression analysis was used to determine the association between neurologists’ characteristics and TI.ResultsA total of 78 neurologists were included (median interquartile range [IQR] age: 36.0 [29.0–46.0] years, 55.1% male, median [IQR] experience managing demyelinating conditions was 5.2 [3.0–11.1] years). The majority of participants were general neurologists (59.0%) attending a median (IQR) of 5.0 NMOSD patients (3.0–12.0) annually. Thirty participants (38.5%) were classified as having TI. Working in a low complexity hospital and giving high importance to patient’s tolerability/safety when choosing a treatment were predictors of TI.ConclusionTI is a common phenomenon among neurologists managing NMOSD AQP4+. Identifying TI and implementing specific intervention strategies may be critical to improving therapeutic decisions and patient care.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Therapeutic inertia in the management of neuromyelitis optica spectrum disorder

Cobo-Calvo,

Gómez-Ballesteros,

Orviz

et al. 2024

Front. Neurol.

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“…Approved DMTs for NMOSD have been lacking until very recently when four monoclonal antibodies, sartralizumab, inebilizumab, eculizumab, and ravulizumab, received approvals for AQP4+ NMOSD on the basis of phase-3 clinical trials [13][14][15][16][17][18]. Common treatment recommendations for NMOSD have previously only included off-label regimens with immunosuppressive agents such as azathioprine (AZA), methotrexate, and mycophenolate mofetil (MMF), with support from real-world studies, case series, and small randomized trials [19][20][21][22][23][24]. Following results from a phase-3 randomized placebo-controlled trial [25] in addition to real-world data [26][27][28], rituximab was recommended as first-line maintenance therapy in AQP4+ NMOSD by the European Federation of Neurological Societies [29] and in the 2015 recommendations of the Neuromyelitis Optica Study Group [30] and later updates [31].…”

Section: Introductionmentioning

confidence: 99%

Relapses and Serious Infections in Patients with Neuromyelitis Optica Spectrum Disorder Treated with Rituximab: A Swedish Single-Center Study

Carlsson,

Jonsson,

Brundin

et al. 2024

JCM

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Neuromyelitis optica spectrum disorder (NMOSD) is a rare immune-mediated relapsing-remitting disease of the central nervous system. The usage of rituximab, as relapse-preventive therapy, in NMOSD is common. We performed a single-center retrospective cohort study to assess the risk of relapses and severe infectious events (SIEs) in rituximab-treated NMOSD patients. This study included 24 aquaporin-4 IgG+ (AQP4+), 8 myelin-oligodendrocyte-protein IgG+ (MOG+), and 10 double-seronegative NMOSD patients. Relapses were observed in 50% of all patients during a mean treatment time of 4.0 (range: 0.5–8.25) years. The incidence risk ratio (IRR) of relapse was three times higher in MOG+ compared to AQP4+ patients (IRR: 3.0, 95% confidence interval (CI); 1.2–7.7). SIEs occurred in 40% of all patients during follow-up. AQP4+ patients conferred an increased risk of SIEs compared to MOG+ patients (IRR; 5.3, 95% CI; 1.2–24.3). Incomplete CD19+ B-lymphocyte suppression was not correlated with relapse risk (hazard ratio; 1.9, 95% CI; 0.7–5.2), and there was no correlation between IgG-levels and SIE risk (odds ratio; 2.0, 95% CI; 0.8–4.8). In conclusion, considerable risks of both relapses and SIEs were observed in NMOSD patients exposed to rituximab, which underlines the need for close clinical vigilance of disease activity and infections during treatment.

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