The Payor Dilemma With Accessing Effective Therapies for NMOSD: Bruce Cree, MD, PhD, MAS, FAAN


The clinical research director of the UCSF Multiple Sclerosis Center talked about challenges in accessibility for the 3 approved therapies for NMOSD caused by third-party payor resistance as well as the importance of educating clinicians about the effectiveness of inebilizumab. [WATCH TIME: 3 minutes]

WATCH TIME: 3 minutes

"There's a significant amount of work required at the payor level for all 3 of these approved therapies. This work involves removing the obstacles that force the use of unproven, off-label experimental therapies as a first step and instead, facilitate the use of ones that have undergone rigorous regulatory approval and demonstrated benefits. I believe, in my mind, this is an area that we need to continue to work on."

Since 2019 neuromyelitis optica spectrum disorder (NMOSD) has had 3 FDA approved treatments which include eculizumab (Soliris; Alexion), inebilizumab (Uplizna; Horizon Therapeutics), and satralizumab (Enspryng; Genentech). In a recent survey of 33 academic neuroimmunologists from 18 states in the US, approximately 88% reported using novel NMOSD treatments (NNTs). Results showed that it was uncommon for clinically stable patients to switch to NNTs, as 69% switched to none and 22% switched between 1% and 25% of their patients. It was noted by respondents that a common challenge with treatment was insurance and cost-related barriers.1

Lead author Bruce Cree, MD, PhD, MAS, FAAN, the clinical research director of the UCSF Multiple Sclerosis Center, presented data on the efficacy of inebilizumab in an AQP4+ NMOSD subpopulation from N-MOmentum open-label extension study at MSMilan 2023, the joint ECTRIMS-ACTRIMS meeting, held October 11–13, in Milan, Italy, October 11–13, in Milan, Italy. In the presented analysis, investigators compared the treatment effects with azathioprine, immunosuppressants, and placebo. Findings showed that patients treated with inebilizumab were associated with a statistically significant reduction in risk of an attack in comparison with other treatments and no treatment administered.2

Cree sat down in an interview with NeurologyLive® at the recently concluded meeting to discuss how these approved treatments for NMOSD impact the landscape of care for patients and some of their lingering challenges. He explained why third-party payors are resistant to the use of high-cost medications despite their FDA approval. Cree also spoke about how the medical community can educate general neurologists about the superiority of inebilizumab over other treatments for NMOSD. In addition, he talked about the main challenges patients face in accessing approved therapies for the disease, and what can be done to address them.

Click here for more coverage of MSMilan 2023.

1. Thon JM, Sharkus R, Thakkar R, Hunter K, Siegler JE, Thon OR. Utilization of FDA approved treatments for neuromyelitis optica spectrum disorder in clinical practice: A survey study of academic neuroimmunologists. Mult Scler Relat Disord. 2023;80:105076. doi:10.1016/j.msard.2023.105076
2. Cree B, Suero B, Walsh S, et al. Long-Term Comparative Efficacy of Inebilizumab in the AQP4+ Subpopulation from the N-MOmentum Open-Label Extension Versus Azathioprine and Immunosuppressive Therapies and Versus Placebo in Patients with NMOSD. Presented at: 2023 MSMilan; October 11-12; Milan, Italy. Abstract P409.
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