To quantify treatment preferences and predict treatment choices between ravulizumab and other approved treatments (eculizumab, inebilizumab, satralizumab) among US adults with NMOSD.

The 4 treatments approved to date in the United States for NMOSD vary with respect to their benefit-risk profiles and mode and frequency of administration, and no published studies have reported NMOSD treatment preferences among US adult patients.

A cross-sectional, web-based survey using a discrete choice experiment (DCE) was developed and administered to US adults self-reporting a physician diagnosis of anti-aquaporin-4 antibody-positive NMOSD. Survey respondents evaluated pairs of hypothetical NMOSD treatment profiles defined by efficacy, risk, process-related attributes, and mode and frequency of administration. DCE data were analyzed using a random parameters logit model, which were used to estimate conditional relative attribute importance, minimum acceptable benefit, and predicted treatment choice in pairwise treatment profile (ravulizumab-like, eculizumab-like, inebilizumab-like, satralizumab-like) comparisons.

Among the 255 survey completers, average age was 41 years, 64% identified as female, 34%/18%/16% were receiving rituximab/azathioprine/eculizumab, and average time since diagnosis was 6.5 years. Respondents placed the most importance on reducing chance of relapse within the first year of treatment, followed by reducing administration frequency from every 2 weeks to every 8 weeks. Respondents placed similar levels of importance on avoiding the risks of serious or opportunistic infection, elevated liver enzymes, and meningococcal infection, requiring only a 5.9%, 5.1%, and 5.8% reduction in chance of relapse to offset each risk, respectively. Based on DCE results, pairwise comparisons indicated that the average probabilities of selecting a ravulizumab-like profile (67.8%-87.7%) exceeded those for the other 3 treatment profiles (12.3%-32.2%).

These results show that patients with NMOSD place the highest value on reducing relapse risk and are more likely to select a ravulizumab-like profile than the others assessed. These findings can inform shared decision-making in selecting NMOSD treatments.