Low Incidence of Relapses After Vaccination in Anti-Aquaporin-4 Antibody-Positive NMOSD

Area of Science:

• Neurology
• Immunology
• Vaccinology

Background:

• Neuromyelitis optica spectrum disorder (NMOSD) is a severe autoimmune condition affecting the central nervous system.
• Complement component 5 (C5) inhibitors are a therapeutic option for NMOSD.
• Meningococcal vaccination is often recommended, but its impact before C5 inhibitor therapy is not fully understood.

Purpose of the Study:

• To evaluate the incidence of relapses in NMOSD patients following meningococcal vaccination prior to C5 inhibitor therapy.
• To assess the safety of meningococcal vaccination in the context of C5 inhibitor treatment for NMOSD.

Main Methods:

• Retrospective analysis of data from clinical trials (CHAMPION-NMOSD, PREVENT) and Japanese postmarketing surveillance.
• Inclusion of patients with anti-aquaporin-4 antibody-positive NMOSD receiving eculizumab or placebo.
• Assessment of physician-reported relapses within 4 weeks of meningococcal vaccination.

Main Results:

• A low overall incidence of physician-reported relapses (mean [range], 3.3% [0.7%-10.6%]) was observed within 4 weeks post-vaccination.
• The study included patients from multiple cohorts, including those screened in CHAMPION-NMOSD and randomized in PREVENT, as well as Japanese postmarketing surveillance data.

Conclusions:

• Meningococcal vaccination prior to C5 inhibitor therapy in NMOSD patients appears to be associated with a low incidence of early relapses.
• Further investigation is required to ascertain whether observed post-vaccination relapses are causally linked to the vaccination or represent the inherent relapse risk in this patient population.