Survey Reports Relapse Prevention as Key Driver of Treatment Preferences in NMOSD

In a recently published, U.S.-based cross-sectional survey study, results demonstrated that patients with antiaquaporin-4 antibody–positive (AQP4-Ab+) neuromyelitis optica spectrum disorder (NMOSD) prioritized reduction in relapse risk as the most important treatment attribute. The findings, published in The Patient: Patient-Centered Outcomes Research, also showed that respondents preferred treatments with less frequent administration and certain therapies without risk of specific adverse events.¹

Among 255 survey completers, the mean age was 41.4 (SD, 13.7) years, with a mean disease duration of 6.6 (SD, 5.4) years; 63.5% identified as women and 46.7% as Black or African American. Rituximab was the most commonly reported treatment (34.1%), whereas 15.7%, 9.4%, and 7.1% of respondents were receiving eculizumab (Soliris; Alexion), inebilizumab (Uplizna; Amgen), or satralizumab (Enspryng; Genentech), respectively. Notably, no respondents were treated with ravulizumab (Ultomiris; Alexion) since the survey was performed prior to its approval for NMOSD.

In the analysis, reducing the probability of relapse in the first year of treatment was weighted more heavily than other attributes, with reducing relapse risk from 50% to 15% or from 50% to 0% being 5.4-fold and 7.0-fold more important, respectively, than reducing administration frequency from every 2 weeks to every 8 weeks. Safety attributes were rated more similarly, with avoiding treatments associated with a risk of meningococcal infection being approximately equivalent in importance to avoiding those with a risk of serious opportunistic or recurrent infection.

“Among patients with a chronic disease such as AQP4-Ab+ NMOSD, the choice of a maintenance treatment relies on a number of attributes that include efficacy, risk of side effects, need for pretreatment and maintenance requirements, and frequency and mode of administration,” lead author Justin R. Abbatemarco, MD, a neurologist in the Mellen Center for Multiple Sclerosis at Cleveland Clinic's Neurological Institute, and colleagues wrote.¹ “The treatment options currently approved in the USA for AQP4-Ab+ NMOSD vary in their mechanisms of action and suitability for different clinical needs and situations, but head-to-head comparison data are limited, and no preference assessment studies have been published.”

READ MORE: Long-Term Tocilizumab Treatment Shows Sustained Relapse Reduction in MOGAD

Investigators assessed treatment preferences and predicted treatment choices among US patients with NMOSD using a web-based discrete choice experiment survey.² In the survey, respondents evaluated hypothetical treatment profiles defined by efficacy, safety, process-related attributes, and administration mode and frequency. Data were analyzed using a random-parameters logit model to estimate relative attribute importance, minimum acceptable benefit, and predicted choices across pairwise comparisons of profiles resembling NMOSD approved therapies. In addition, researchers explored preference heterogeneity through subgroup analyses incorporating interaction terms in the regression analysis.

In pairwise comparisons, the ravulizumab-like profile was selected more frequently than the eculizumab-like profile (67.8% versus 32.2%), the inebilizumab-like profile (75.2% versus 24.8%), and the satralizumab-like profile (87.7% versus 12.3%). Authors noted that treatment preferences did not differ by age, disease duration, disease impact, or number of relapses in the past 12 months; however, subgroups defined by current treatment type demonstrated different preferences (P = 0.066).

Across subgroups defined by current treatment experience, reducing the risk of relapse in the first year of treatment demonstrated the highest importance in respondents. However, individuals who received intravenous (IV) or subcutaneous (SC) therapies alone or in combination with oral therapies assigned greater importance to relapse risk reduction than those receiving oral therapies alone. Those who received oral therapies alone also showed a preference for SC administration over IV infusion and demonstrated stronger preferences for avoiding treatments associated with risks of serious opportunistic or recurrent infection.

“These findings can support shared decision-making in selecting treatments for patients with AQP4-Ab+ NMOSD by providing information on treatment characteristics that patients prioritize and the trade-offs they are prepared to make between attributes such as treatment benefits, administration mode and frequency, and safety,” Abbatemarco et al noted.¹ “Healthcare professionals can use these findings to inform and support shared decision-making to develop a treatment plan that aligns with the individual patient’s preferences prior to finalizing the treatment selection.”

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REFERENCES
1. Abbatemarco JR, Kielhorn A, Yu JC, et al. Patient Preferences for Neuromyelitis Optica Spectrum Disorder (NMOSD) Treatments: Results from a Discrete Choice Experiment Study in the USA. Patient. Published online January 7, 2026. doi:10.1007/s40271-025-00797-9
2. Soekhai V, Whichello C, Levitan B, et al. Methods for exploring and eliciting patient preferences in the medical product lifecycle: a literature review. Drug Discov Today. 2019;24(7):1324-1331. doi:10.1016/j.drudis.2019.05.001