NMOSD Treatment Landscape and Pipeline: Brian G. Weinshenker, MD

"If you ask me, ‘Is there something we can do to test in a particular patient to see if they would respond best to drug A, B, or C best?’ We don’t really have that. All of these mechanisms apply to all patients and we can’t individualize treatments just yet."

Within a stretch of just over a year, the first 3 therapies to treat relapses in patients with neuromyelitis optica spectrum disorder (NMOSD), a rare autoimmune inflammatory disorder, were approved by the FDA. Eculizumab (Soliris; Alexion) began the domino effect with its approval in June 2019, followed by inebilizumab (Uplizna; Viela Bio) in June 2020, and satralizumab (Enspryng; Genentech) in August 2020. All 3 are also currently indicated to treat aquaporin-4 autoantibody-positive patients with NMOSD.

Despite sharing the same indications, each drug is vastly different in its mechanism of action and how it is administered. Satralizumab remains the only subcutaneous treatment, designed to target and inhibit interleukin-6 (IL-6) receptor activity by binding to the IL-6 receptor. On the other hand, eculizumab is a first-in-class compliment inhibitor that binds to complement protein C5 and prevents the inappropriate activation of the complement system. Inebilizumab is a humanized anti-CD19 monoclonal antibody that is designed to deplete CD19+ B cells and plasmablasts responsible to produce autoantibodies directed against AQP4.

To gain a better understanding of the currently approved therapies, and any high potential investigational agents, NeurologyLive turned to Brian G. Weinshenker. Weinshenker, professor of neurology, Mayo Clinic College of Medicine, has previously conducted multiple research projects related to inflammatory demyelinating diseases of the central nervous system.