Abstract Details

Title Efficacy of Rituximab and Inebilizumab in Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease (MOGAD): A Real-World Study

Topic Autoimmune Neurology

Presentation(s) P3 - Poster Session 3 (12:00 PM-1:00 PM)

Poster/Presentation
Number 047

Objective To determine relapse-free survival probabilities in MOGAD patients on rituximab, compare these to inebilizumab, and determine predictors of rituximab failure

Background Rituximab efficacy in myelin oligodendrocyte glycoprotein Antibody Disease (MOGAD) relapse prevention is controversial, with some groups finding moderate success, while our group has found significantly lower efficacy compared to IVIG.

Design/Methods We performed a retrospective analysis of MOGAD patients at Mass General Brigham. We conducted a Kaplan-Meier survival analysis for patients treated with rituximab and extracted relapse freedom probabilities at 6, 12, 18, 24, and 30 months. We determined survival probabilities from the Kaplan-Meier curves of MOG-IgG positive patients in the inebilizumab NMO-mentum trial. We then performed a multivariate Cox proportional hazards analysis to determine predictors of rituximab failure.

Results 201 patients with MOGAD were identified. 56 patients received at least one course of rituximab. Mean age of disease onset was 39.6 years (SD 16.0), and 58.9% were female. 62.5% of patients had never received any prior treatment before starting rituximab. Relapse-free survival probabilities were 60.7% at 6 months, 51.1% at 12 months, and 41.8% at 18 months. The N-MOmentum trial for inebilizumab included 7 MOG IgG positive patients. Only 1/7 patients had a relapse at the end of the open label extension. Using the 18-month relapse probabilities from rituximab-treated MOGAD patients, the probability of observing 1 relapse over this time course is 4.5%, assuming similar efficacy. In a multivariate Cox model, patients who never smoked had a lower risk of failure (HR 0.06, 95% CI 0.00012-0.31), while a one-unit increase in BMI was associated with a higher risk of failure (HR 1.36, 95% CI 1.03-1.79).

Conclusions The rituximab failure rate is significant in our cohort, in contrast to the relative efficacy of inebilizumab. This may reflect differences in accessing pathogenic B cells or inebilizumab-mediated depletion of plasmablasts and short-lived plasma cells.

Authors/Disclosures
Philippe-Antoine Bilodeau, MD (Massachusetts General Hospital) PRESENTER	Dr. Bilodeau has nothing to disclose.
Takahisa Mikami, MD (Massachusetts General Hospital)	Dr. Mikami has nothing to disclose.
Anastasia Vishnevetsky, MD (Massachusetts General Hospital)	The institution of Dr. Vishnevetsky has received research support from National MS Society. The institution of Dr. Vishnevetsky has received research support from NIH (NeuroNext).
Monique Anderson, MD, PhD (Mass General Hospital)	Dr. Anderson has nothing to disclose.
Mattia Wruble, MD	The institution of Dr. Wruble has received research support from Alexion. The institution of Dr. Wruble has received research support from Roche.
Rebecca L. Gillani, MD (Massachusetts General Hospital)	The institution of Dr. Gillani has received research support from The Phyllis and Jerome Lyle Rappaport Foundation. The institution of Dr. Gillani has received research support from McCourt Foundation . The institution of Dr. Gillani has received research support from Roche.
Gabriela Romanow (Massachusetts General Hospital)	Gabriela Romanow has nothing to disclose.
Rebecca Salky	Rebecca Salky has nothing to disclose.
Melanie Delgado (NIH)	Melanie Delgado has nothing to disclose.
Michael Levy, MD, PhD, FAAN (Massachusetts General Hospital/Harvard Medical School)	Dr. Levy has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Mitsubishi Pharma. Dr. Levy has received personal compensation in the range of $500-$4,999 for serving as a Consultant for UCB Pharma. Dr. Levy has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Sanofi. Dr. Levy has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. Dr. Levy 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. Levy has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. Dr. Levy has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Elsevier. Dr. Levy has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Various law firms. The institution of Dr. Levy has received research support from National Institutes Health.

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