Efficacy of Switching From to Inebilizumab in Rituximab in NMOSD: Michael Levy, MD, PhD

WATCH TIME: 4 minutes

"What surprised us is that there were quite a few relapses in the rituximab group, pretty similar to the numbers in the trials."

Neuromyelitis optica spectrum disorder (NMOSD), a rare autoimmune disorder of the central nervous system, is characterized by recurrent, disabling attacks that impact the optic nerve, spinal cord, and brainstem. Although rituximab, which targets CD20-positive B-cells, is typically used as an off-label therapy in NMOSD, some patients continue to experience releases or adverse reactions. Inebilizumab (Uplizna; Amgen), an FDA-approved treatment for NMOSD in adult patients who are anti-aquaporin-4 antibody positive, is a humanized and glycoengineered monoclonal antibody targeting CD19-positive B-cells, representing a unique mechanism of action to treat.

Newly published in Frontiers in Neurology, a retrospective chart review on 14 cases of NMOSD from 7 centers showed that inebilizumab provided clinical benefit with effective disease control and a favorable safety profile for patients transitioning from rituximab.¹ Conducted by senior author Michael Levy, MD, PhD, associate professor of neurology at Harvard Medical School, and colleagues, 71.4% (n = 10) of patients experienced a combined 17 attacks on rituximab because of either breakthrough disease (n = 10) or treatment delay (n = 7). The mean duration of rituximab treatment was 38.4 months and mean duration of inebilizumab treatment was 19.3 months. Notably, after switching to inebilizumab, investigators did not observe any subsequent attacks.

Levy, who also serves as the chairman for the medical advisory board at The Sumaira Foundation, recently sat down with NeurologyLive^® in an interview to discuss the potential reasons for inadequate response to rituximab in some patients, noting complications with fully depleting B cells. He also talked about of the cost difference between the 2 therapies, and how this may impact inebilizumab’s adoption in clinical practice. Furthermore, Levy, research director of the Division of Neuroimmunology & Neuroinfectious Disease at Massachusetts General Hospital, explained that further studies are needed to understand why some patients respond better to inebilizumab than to rituximab.

REFERENCES
1. Osborne B, Romanow G, Hemphill JM, et al. Case report: Transition from anti-CD20 therapy to inebilizumab for 14 cases of neuromyelitis optica spectrum disorder. Front Neurol. 2024;15:1352779. Published 2024 Apr 16. doi:10.3389/fneur.2024.1352779