Modafinil Effective for Treating EDS, Ravulizumab Controls NMOSD, Regardless of Rituximab Use, Reviewing 2026 Q1 FDA Approvals

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Welcome to the Neurology News Network. My name is Louie Pasculli. Here’s a look at this week’s top stories in neurology.

Beginning in sleep medicine, an updated systematic review and meta-analysis of randomized clinical trials reinforces the role of modafinil as an effective short-term treatment for excessive daytime sleepiness (EDS) in narcolepsy, while also highlighting a notable lack of contemporary randomized evidence in the field.¹

In the analysis, study authors, including lead author Govind Singh Mann, a resident at the University of Kansas Department of Neurology, identified 9 eligible studies through a comprehensive search of major databases, with 5 randomized controlled trials comprising 997 adult patients included in the quantitative meta-analysis. Across these studies, modafinil demonstrated statistically significant improvements in both objective and subjective measures of wakefulness compared with placebo.

On the Maintenance of Wakefulness Test (MWT), modafinil-treated patients showed a mean increase of 3.56 minutes (95% CI, 2.25–4.86; P <.00001), reflecting improved ability to sustain wakefulness. Similarly, treatment was associated with a reduction of 3.34 points on the Epworth Sleepiness Scale (ESS) (95% CI, –4.13 to –2.56; P <.00001), indicating a clinically meaningful decrease in perceived daytime sleepiness.

Switching gears to NMOSD Treatment, A new post hoc analysis of the CHAMPION-NMOSD trial (NCT04201262) revealed that ravulizumab-cwvz (Ultomiris; Alexion) treatment was associated with sustained disease control and a manageable safety profile in patients with aquaporin-4 antibody-positive (AQP4-Ab+) neuromyelitis optica spectrum disorder (NMOSD), regardless of prior exposure to rituximab. The findings, published in the Multiple Sclerosis Journal, showed no adjudicated relapses during treatment with ravulizumab-cwvz in either subgroup.²

Prior efficacy data from the trial showed that there were no patients that had adjudicated relapses with ravulizumab-cwvz versus 20 with placebo (relapse risk reduction [RRR], 98.6%; P <.0001). The annualized relapse rate (ARR) of those on the therapy was 0.00 (upper 95% CI, 0.04), which was superior to a predefined comparator ARR (0.25; P <.0001). There were fewer patients who experienced clinically important Hauser Ambulation Index score worsening with ravulizumab (2 out of 58 patients; 3.4%) compared with placebo (11/47; 23.4%; P = .023), demonstrated by odds ratio of 0.16 (95% CI, 0.03–0.77).3

“The results of this post hoc analysis support consideration of ravulizumab for patients previously treated with [rituximab] and may inform future research aimed at advancing personalized treatment strategies for patients with NMOSD,” lead author Jeffrey L. Bennett, MD, PhD, professor of neurology and ophthalmology at the University of Colorado School of Medicine, and colleagues wrote.1 “Future work should include observational studies and real-world data analyses to characterize long-term outcomes after treatment transitions, as well as biomarker-based investigations of immune reconstitution to refine sequencing strategies and timing between [rituximab] and complement inhibition.”²

Ending with FDA decisions, the first quarter of 2026 represented a notable period of progress in neurological care, highlighted by several FDA drug approvals targeting complex and rare conditions. These included first-of-their-kind therapies for ultra-rare disorders such as neurologic Hunter syndrome and cerebral folate transport deficiency, as well as new treatment formulations for spinal muscular atrophy (SMA). Collectively, these regulatory decisions reflect continued developments in the management of neurologic diseases.

On January 5, 2026, the FDA approved ScinoPharm Taiwan’s glatiramer acetate (GA) injection as a treatment for relapsing multiple sclerosis (MS), making it the first complex injectable generic approval for this therapy.⁴

GA, originally marketed as Copaxone in 1996, has been recognized as one of the most challenging complex synthetic polypeptides globally. This newly approved version is a nonbiological complex drug generic, meaning it has the same active, route, and typical strengths of traditional GA, mirroring the Copaxone label.

To read the full piece and to get more direct access to expert insight, head to NeurologyLive.com. Be sure to tune in next week to stay up to date on the latest in neurology. I’m Louie Pasculli, thanks for watching Neurology News Network.

REFERENCES
1. Mann GS, Ramakrishnan M, Pakkam M, et al. An updated systematic review and meta-analysis of modafinil for excessive daytime sleepiness in narcolepsy. Sleep Med. 2026;11:100185. doi:10.1016/j.sleepx.2026.100185
2. Bennett JL, Bhattacharyya S, Zabeti A, et al. Safety and efficacy of ravulizumab in patients with NMOSD previously treated with rituximab: A post hoc analysis of the CHAMPION-NMOSD trial. Mult Scler. 2026;32(4):396-408. doi:10.1177/13524585261425076
3. Pittock SJ, Barnett M, Bennett JL, et al. Ravulizumab in Aquaporin-4-Positive Neuromyelitis Optica Spectrum Disorder. Ann Neurol. 2023;93(6):1053-1068. doi:10.1002/ana.26626
4. ScinoPharm secures U.S. FDA approval for glatiramer acetate injection for the treatment of multiple sclerosis. News release. ScinoPharm. January 5, 2025. Accessed April 6, 2026. https://www.prnewswire.com/news-releases/scinopharm-secures-us-fda-approval-for-glatiramer-acetate-injection-for-the-treatment-of-multiple-sclerosis-302652370.html