Different monoclonal antibodies and immunosuppressants administration in patients with neuromyelitis optica spectrum disorder: a Bayesian network meta-analysis

Abstract

Background A variety of novel monoclonal antibodies and immunosuppressant have been proved effective in treating Neuromyelitis Optica Spectrum Disorder (NMOSD). This network meta-analysis compared and ranked the efficacy and tolerability of currently used monoclonal antibodies and immunosuppressive agents in NMOSD. Methods Electronic database including PubMed, Embase and Cochrane Library were searched for relevant studies evaluating monoclonal antibodies and immunosuppressants in patients with NMOSD. The primary outcome measures were annualized relapse rate (ARR), relapse rate, the Expanded Disability Status Scale (EDSS) score, and total adverse events (AEs). Results We identified 25 studies with 2919 patients in our meta-analysis. For the primary outcome, rituximab (RTX) (SUCRA: 0.02) ranked first in reduction ARR with a significant difference compared with azathioprine (AZA) (MD – 0.34, 95% CrI – 0.55 to – 0.12) and mycophenolate mofetil (MMF) (MD –0.38, 95% CrI – 0.63 to – 0.14). Tocilizumab (SUCRA: 0.05) ranked first in relapse rate, which was superior to satralizumab (lnOR – 25.4, 95% CrI – 74.4 to – 2.49) and inebilizumab (lnOR – 24.86, 95% CrI – 73.75 to – 1.93). MMF (SUCRA: 0.27) had the fewest AEs followed by RTX (SUCRA: 0.35), both of which showed a significant difference compared with AZA and corticosteroids (MMF vs AZA: lnOR – 1.58, 95% CrI – 2.48 to – 0.68; MMF vs corticosteroids: lnOR – 1.34, 95% CrI – 2.3 to – 0.37) (RTX vs AZA: lnOR – 1.34, 95% CrI – 0.37 to – 2.3; RTX vs corticosteroids: lnOR – 2.52, 95% CrI – 0.32 to – 4.86). In EDSS score, no statistical difference was found between different interventions. Conclusion RTX and tocilizumab showed better efficacy than traditional immunosuppressants in reducing relapse. For safety, MMF and RTX had fewer AEs. However, studies with larger sample size on newly developed monoclonal antibodies are warranted in the future.

Treatment access and satisfaction on disease-modifying therapies of neuromyelitis optica spectrum disorder patients in China: a cross-sectional survey

“… 37 MMF was favored over rituximab probably due to its convenience as an oral drug and the significant cost reduction; as compared to AZA, it is supposed that MMF was preferred for its slight advantage in observed safety in the Chinese patient population. 43 – 45 Drug supply may be another real-world factor influencing the choice of therapy by prescribers, which is beyond the scope of this study.…”