Immunotherapies in neuromyelitis optica: Bayesian network meta-analysis.

Area of Science:

• Neurology
• Immunology
• Clinical Trials

Background:

• Neuromyelitis optica spectrum disorder (NMO-SD) has multiple effective immunotherapies for relapse prevention.
• Head-to-head trials comparing these treatments are scarce.
• Bayesian network meta-analysis offers a method to compare interventions when direct trial data is limited.

Purpose of the Study:

• To compare the efficacy of various immunosuppressive treatments for preventing relapses in NMO-SD.
• To identify the most effective treatment for NMO-SD relapse reduction.

Main Methods:

• A systematic search of PubMed, EMBASE, and Scopus was conducted for randomized controlled trials up to September 20, 2024.
• Included trials focused on immunotherapies for NMO-SD relapse reduction.
• Bayesian fixed-effect network meta-analysis was performed, with time to relapse as the primary outcome.

Main Results:

• Eight trials involving 851 patients were analyzed, comparing ravulizumab, eculizumab, tocilizumab, rituximab, inebilizumab, satralizumab, and a control arm.
• Ravulizumab demonstrated superior efficacy in increasing time to relapse (HR 0.00, SUCRA 0.99).
• These findings were consistent across secondary analyses of annualized relapse rate and in seropositive patients.

Conclusions:

• Ravulizumab shows the highest probability of being the most effective treatment for reducing relapse risk in NMO-SD.
• This analysis provides valuable comparative data for NMO-SD treatment selection.