Abstract Details

Title Trends in Management Practices of Seropositive Neuromyelitis Optica Spectrum Disorder: Lessons from a Multicenter Academic Cohort

Topic Autoimmune Neurology

Presentation(s) P10 - Poster Session 10 (11:45 AM-12:45 PM)

Poster/Presentation
Number 14-010

Objective To characterize evolving management of neuromyelitis optica spectrum disorder (NMOSD) in clinical practice.

Background Timely initiation of high-efficacy DMT is critical for preventing disability in NMOSD. Three targeted disease-modifying therapies (DMTs) for aquaporin 4-seropositive NMO have been recently approved and augment existing treatments such as rituximab. Real-world data on factors likely to influence management decisions, such as treatment epoch or race/ethnicity, are lacking.

Design/Methods A multicenter collaboration was established to evaluate real-world NMOSD outcomes. Demographic and clinical data were retrospectively collected from medical records of seropositive NMO patients from two participating centers. Treatment epochs were divided into pre-2010 (N=25), 2010-2018 (N=71), and 2019+ (N=37). Comparisons were performed using Pearson’s chi2 or Wilcoxon rank sum test.

Results

These 163 seropositive patients were predominantly female (86.5%) and racially diverse (Asian, 18.4%; Black 26.4%; Non-Hispanic White, 23.9%; Hispanic 21.5%). Median (IQR) baseline EDSS was 4(2.5-6.5). The most common initial DMT across all epochs was rituximab (48.0%, 61.1%, 51.3%). The second most common initial DMT varied: MS-specific therapies pre-2010 (36%), mycophenolate mofetil 2010-2019 (22.2%), and eculizumab 2019+ (24.3%). Since 2019+, newer agents were rarely the initial prescription (inebilizumab, 8.1%; satralizumab: 0%). Key factors influencing choice of new FDA-approved DMT were perceived drug efficacy (42.8%), side effect profile (28.5%), and dosing schedule (11.4%). A preliminary investigation revealed no association between race/ethnicity and differences in baseline EDSS, number of medication trials, or use of FDA-approved DMT (p>0.05 for each).

Conclusions In this cohort, despite introduction of new NMOSD DMTs, rituximab remained the most widely used. Treatment decisions appeared based primarily on disease activity and therapy-specific features, with no apparent association with patient race. Further work in the larger geographically diverse collaborative cohort will explore the potential impact of race/ethnicity and other sociodemographic factors on early access to NMOSD specialist care and its impact on disease outcomes.

Authors/Disclosures
Leah Zuroff, MD (Hospital of the University of Pennsylvania) PRESENTER	Dr. Zuroff has received personal compensation in the range of $500-$4,999 for serving as a Speaker with EMD Serono.
Jaeleene Wijangco	Jaeleene Wijangco has nothing to disclose.
Rachel Brandstadter, MD (University of Pennsylvania)	Dr. Brandstadter has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Alexion.
Myla D. Goldman, MD, MSc, FAAN (Virginia Commonwealth University)	Dr. Goldman has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Genentec. Dr. Goldman has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Immunic. Dr. Goldman has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Novartis Pharmceuticals. Dr. Goldman has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Kiniska. Dr. Goldman has received personal compensation in the range of $500-$4,999 for serving as a Consultant for TG Therapeutics. Dr. Goldman has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Brainstorm Cell Therapeutics Ltd., . Dr. Goldman has received personal compensation in the range of $500-$4,999 for serving as a Study Section Member with NIH. Dr. Goldman has received personal compensation in the range of $0-$499 for serving as a Grant Review Committee Member with Department of Defense.
Edith Graham, MD (Northwestern University)	Dr. Graham has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Graham has received personal compensation in the range of $500-$4,999 for serving as a Consultant for TG Therapeutics. The institution of Dr. Graham has received research support from F. Hoffman-La Roche Ltd. The institution of Dr. Graham has received research support from Novartis.
Rebecca Farber	No disclosure on file
Navid Valizadeh, MBBS (University of Texas at Austin)	Dr. Valizadeh has nothing to disclose.
Leorah A. Freeman, MD, PhD (Dell Medical School, The University of Texas at Austin)	Dr. Freeman has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Freeman has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Hoffman La-Roche. Dr. Freeman has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech, Inc. Dr. Freeman has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for EMD Serono. Dr. Freeman has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Horizon. Dr. Freeman has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sanofi. Dr. Freeman has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for TG Therapeutics. Dr. Freeman has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Sanofi-Genzyme. Dr. Freeman has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Texas Neurological Society. Dr. Freeman has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for EMD Serono/ Merck. The institution of Dr. Freeman has received research support from Genentech. The institution of Dr. Freeman has received research support from PCORI. The institution of Dr. Freeman has received research support from EMD Serono. The institution of Dr. Freeman has received research support from Sanofi. The institution of Dr. Freeman has received research support from MSAA. The institution of Dr. Freeman has received research support from National Multiple Sclerosis Society.
Bruce A. Cree, MD, PhD, MAS, FAAN (UCSF, Multiple Sclerosis Center)	The institution of Dr. Cree has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Biogen. The institution of Dr. Cree has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Novartis. The institution of Dr. Cree has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Sanofi. The institution of Dr. Cree has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for TG Therapeutics. The institution of Dr. Cree has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Alexion. Dr. Cree has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Neuron23. Dr. Cree has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Boston Pharma. Dr. Cree has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Hexal/Sandoz. Dr. Cree has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Immunic AG. The institution of Dr. Cree has received research support from Genentech. The institution of Dr. Cree has received research support from Kyverna. Dr. Cree has received publishing royalties from a publication relating to health care.
Riley Bove, MD, FAAN (University of California, San Francisco)	Dr. Bove has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Alexion. Dr. Bove has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Amgen. Dr. Bove has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Genzyme-Sanofi. Dr. Bove has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for TG Therapeutics. Dr. Bove has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for EMD-Serono. Dr. Bove has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Cadenza. The institution of Dr. Bove has received research support from Biogen. The institution of Dr. Bove has received research support from Eli Lilly. The institution of Dr. Bove has received research support from Novartis. The institution of Dr. Bove has received research support from Roche Genentech.
Dina Jacobs, MD (Hosp of Univ of PA/Dept of Neruo)	Dr. Jacobs has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Genentech. Dr. Jacobs has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Merck/EMD Serono. Dr. Jacobs has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Cycle Pharmaceuticals. Dr. Jacobs has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for TG Therapeutics. Dr. Jacobs has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Sanofi . Dr. Jacobs has received personal compensation in the range of $500-$4,999 for serving as a Consultant for William Blair &Company . Dr. Jacobs has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Horizon. Dr. Jacobs has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Dr. Jacobs has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for EMD Serono. Dr. Jacobs has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sanofi . The institution of Dr. Jacobs has received research support from Roche/Genentech .

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