Abstract Details

Title Uncovering Infections in NMOSD: A U.S. Real-world Comparison Between Broad Immunosuppressants and Targeted Immunotherapy

Topic Autoimmune Neurology

Presentation(s) P2 - Poster Session 02 (3:00 PM-4:00 PM)

Poster/Presentation
Number 1-088

Objective

This study compares frequency of infection among patients with neuromyelitis optica spectrum disorder (NMOSD) receiving azathioprine, mycophenolate, rituximab, inebilizumab, satralizumab, or ravulizumab.

Background

MOSD causes debilitating relapses which can result in severe disability. Long-term treatment with immunomodulatory therapies is required to prevent relapses and disability accrual. Several newer FDA-approved biologic therapies are increasingly used, though treatment with longer standing non-FDA approved therapies remains common. Long-term data on real-world infection risk are limited, which makes evidence-based treatment selection challenging for clinicians.

Design/Methods

This retrospective cohort study used CHRONOS hybrid claims data ecosystem to identify adult patients with NMOSD between January 2017 and December 2025. Patients were followed for at least 1 year from first NMOSD treatment and classified into treatment groups of azathioprine, mycophenolate, rituximab, inebilizumab, satralizumab, or ravulizumab. Infection rates were estimated using generalized estimating equations to calculate infection incidence rate ratio (IRR) versus ravulizumab, adjusted for variable treatment duration, age, sex, prior B-cell therapy duration, Charlson comorbidity index, and history of transverse myelitis.

Results

A total of 5,391 patients with NMOSD were treated with at least one of azathioprine (n=507), mycophenolate (n=992), rituximab (n=3460), inebilizumab (n=603), satralizumab (n=344), or ravulizumab (n=215) during their follow-up for 6,121 unique patient treatment periods after accounting for treatment switches. Compared to ravulizumab, azathioprine demonstrated the highest relative infection rate (IRR 1.94, 95% CI 1.52-2.47, p<0.001), followed by mycophenolate (IRR 1.80, 95% CI 1.46-2.23, p<0.001), rituximab (IRR 1.73, 95% CI 1.41-2.11, p<0.001), satralizumab (IRR 1.60, 95% CI 1.23-2.07, p<0.001), and inebilizumab (IRR 1.31, 95% CI 1.05-1.64, p=0.019).

Conclusions

This real-world study demonstrated higher infection rates in broader immunosuppressive therapies used for long-term treatment in patients with NMOSD relative to a more targeted FDA-approved complement inhibitor, ravulizumab. These findings may help inform clinical decision making for those who take care of patients living with NMOSD.

Authors/Disclosures
Philippe-Antoine Bilodeau, MD (Massachusetts General Hospital) PRESENTER	The institution of Dr. Bilodeau has received research support from Alexion Pharmaceuticals. The institution of Dr. Bilodeau has received research support from Department of Defense. Dr. Bilodeau has received research support from Canadian Institutes of Health Research. The institution of Dr. Bilodeau has received research support from Ann Theodore Foundation. Dr. Bilodeau has received research support from The MOG Project.
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.
Phuong Phan, PharmD	Ms. Phan has received personal compensation for serving as an employee of AstraZeneca. Ms. Phan has or had stock in AstraZeneca.
Michael Blackowicz, PhD (Alexion)	Dr. Blackowicz has received personal compensation for serving as an employee of Alexion Pharmaceuticals. Dr. Blackowicz has stock in Alexion Pharmaceuticals.
Emma Weiskopf, MD (Alexion Pharmaceuticals)	Dr. Weiskopf has received personal compensation for serving as an employee of Alexion AstraZeneca Rare Disease. Dr. Weiskopf has or had stock in Alexion Astrazeneca Rare Disease.
Ashwin Anand, MPH	Mr. Anand has nothing to disclose.
Mike Sicilia	Mr. Sicilia has received personal compensation for serving as an employee of Forian, Inc.
Shamik Bhattacharyya, MD, FAAN (Brigham and Women's Hospital)	Dr. Bhattacharyya has received personal compensation in the range of $500-$4,999 for serving as a Consultant for NeuroLambda. Dr. Bhattacharyya 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 Pharmaceuticals. Dr. Bhattacharyya has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Amgen. Dr. Bhattacharyya 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. Bhattacharyya has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Continuum. Dr. Bhattacharyya has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Wiley. Dr. Bhattacharyya has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Merck. The institution of Dr. Bhattacharyya has received research support from Alexion Pharmaceuticals. The institution of Dr. Bhattacharyya has received research support from National Institute of Health. The institution of Dr. Bhattacharyya has received research support from UCB. The institution of Dr. Bhattacharyya has received research support from Genentech. The institution of Dr. Bhattacharyya has received research support from TG Therapeutics. The institution of Dr. Bhattacharyya has received research support from The Sumaira Foundation. Dr. Bhattacharyya has received publishing royalties from a publication relating to health care. Dr. Bhattacharyya has received publishing royalties from a publication relating to health care.

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