Real World Effectiveness and Tolerability of Novel Monoclonal Antibodies and Rituximab for NMOSD

In this multicenter retrospective cohort study of 135 people with aquaporin-4 IgG+ neuromyelitis optica spectrum disorder (NMOSD), some of whom were exposed to multiple therapies, we evaluated the effectiveness and tolerability of rituximab (n = 111) and novel monoclonal antibodies (nMAbs): eculizumab (n = 9), inebilizumab (n = 23), and satralizumab (n = 14). Over a median follow-up of 3.92 years, 21/111 rituximab-treated patients relapsed. In contrast, relapse occurred in only 1/23 inebilizumab-treated patients (median follow-up 1.27 years), with no relapses observed in those receiving eculizumab or satralizumab. Twelve-month relapse-free probabilities were 92% (rituximab), 94% (inebilizumab), and 100% (eculizumab and satralizumab). Among those with available MRI data, 10/73 rituximab and 1/14 inebilizumab developed new lesions. There were no serious adverse events. These findings support nMAbs as effective and well-tolerated first-line therapies for NMOSD.