Abstract Details

Title NMOSD Treatment Patterns in the Era of Approved Biologics: An Analysis from the SPHERES Registry

Topic Autoimmune Neurology

Presentation(s) P3 - Poster Session 3 (5:00 PM-6:00 PM)

Poster/Presentation
Number 1-011

Objective Since 2019, four biologic therapies have been approved to prevent relapses in patients with Neuromyelitis Optica Spectrum Disorder (NMOSD) and aquaporin-4 antibodies (AQP4-IgG+): eculizumab, inebilizumab, ravulizumab, and satralizumab (A-BIOs). It is unclear how these newer therapies are utilized in real-world practice.

Background NMOSD is a rare autoimmune disorder of the Central Nervous System that affects the optic nerves and spinal cord, leading to permanent disability and reduced quality of life.

Design/Methods Patients with NMOSD from the US-based SPHERES (Synergy of Prospective Health & Experimental Research for Emerging Solutions) Registry enrolled from 6/2/2021 to 2/28/2025 were included (adults age ≥18 years diagnosed per 2015 IPND consensus diagnostic criteria). The study sequenced NMOSD therapies by tabulating all prior medication history reported up to the current therapy at the time of analysis. Demographics, lifestyle characteristics, comorbidities, NMOSD and clinical characteristics were summarized.

Results

Of 422 patients, 294 (70%) were AQP4-IgG+, 58 (14%) were myelin oligodendrocyte glycoprotein immunoglobulin G (MOG) seropositive, and 37 (9%) were seronegative. The mean age was 51 years, 84% were female, 58% were White, and 33% were Black/African American. Further, 200 (47%) required second- and 96 (23%) third-line therapy.

For monotherapies, rituximab (43%) was the most prescribed first-line therapy, followed by A-BIOs (21%) and IST (20%). Among the patients requiring second- or third-line monotherapy, A-BIOs were most prescribed (34% and 39%, respectively). Eculizumab and inebilizumab were the most common first-line A-BIOs; inebilizumab and satralizumab second-line; and satralizumab third-line.

Conclusions This study showed a predominant first-line rituximab use followed by A-BIOs; nearly half needed a second-line therapy or higher. We showed a preponderance of rituximab use in earlier lines of therapy, while A-BIOs, specifically inebilizumab, satralizumab, and eculizumab, were used more often as second or higher lines of therapy. Given accumulating disability with repeated attacks, these findings support earlier approved biologic use to prevent relapses.

Authors/Disclosures
Michael Levy, MD, PhD, FAAN (Massachusetts General Hospital/Harvard Medical School) PRESENTER	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.
Dustin Cavida (Amgen)	Mr. Cavida has received personal compensation for serving as an employee of Amgen. Mr. Cavida has stock in Amgen.
Kristina R. Patterson, MD, PhD (Horizon Therapeutics)	Dr. Patterson has received personal compensation for serving as an employee of Amgen. Dr. Patterson has stock in Amgen.
Jenny Y. Park, PharmD, MS	Dr. Park has received personal compensation for serving as an employee of Amgen Inc.. Dr. Park has or had stock in Amgen Inc..
Rajvi J. Wani, PhD	Dr. Wani has nothing to disclose.
Andrea Meyers, DrPH	Dr. Meyers has received personal compensation for serving as an employee of Amgen. Dr. Meyers has stock in Amgen.
Nicole Middaugh, PhD	Dr. Middaugh has nothing to disclose.
Chien-wen J. Choi	Ms. Choi has received personal compensation for serving as an employee of Thermo Fisher Scientific.
Marie Gurrola	Mrs. Gurrola has nothing to disclose.
Jeffrey L. Bennett, MD, PhD, FAAN (University of Colorado School of Medicine)	Dr. Bennett has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Amgen. Dr. Bennett has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Alexion. Dr. Bennett has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Genentech. Dr. Bennett has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Roche. Dr. Bennett has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Mitsubishi Tanabe. Dr. Bennett has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Novartis. Dr. Bennett has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Immpact Bio. Dr. Bennett has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Chugai. Dr. Bennett has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Beigene. Dr. Bennett has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Imcyse. Dr. Bennett has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. Dr. Bennett has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for MIAC. Dr. Bennett has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for CorEvitas. Dr. Bennett has received personal compensation in the range of $50,000-$99,999 for serving on a Speakers Bureau for Alexion. Dr. Bennett has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Vindico. Dr. Bennett has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Touch IME. Dr. Bennett has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Efficient LLC. Dr. Bennett has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Pavich. Dr. Bennett has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Marie Bush. Dr. Bennett has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Marks Gray. Dr. Bennett has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Knight, Nicastro, MacKay. The institution of Dr. Bennett has received research support from Alexion. The institution of Dr. Bennett has received research support from Genentech. Dr. Bennett has received intellectual property interests from a discovery or technology relating to health care. Dr. Bennett has received publishing royalties from a publication relating to health care.

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