Inebilizumab for neuromyelitis optica spectrum disorders

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Item Type:	Review
Title:	Inebilizumab for neuromyelitis optica spectrum disorders
Creators Name:	Schindler, P. and Paul, F.
Abstract:	BACKGROUND: Aquaporin-4-immunoglobulin G-seropositive neuromyelitis optica spectrum disorder (AQP4+ NMOSD) is an autoantibody-mediated, relapsing disease affecting the central nervous system. Relapse-preventive treatment is crucial because each single attack can result in severe disability. First medications for maintenance therapy of AQP4+ NMOSD have only recently been approved. These include the monoclonal anti-CD19 antibody inebilizumab. OBJECTIVE: To provide a review of the mechanism of action, effectiveness, safety and implementation of inebilizumab in AQP4+ NMOSD. METHODS: We conducted a narrative review of the literature. RESULTS: Inebilizumab induces profound B-cell depletion. In contrast to anti-CD20-mediated B-cell depletion, for example, by rituximab, inebilizumab depletes B cells not only in mature but also in early stages, as well as plasmablasts. This may lead to a more profound reduction in antibody titres, but whether this is clinically meaningful remains to be determined. Infections are the most relevant adverse effects of inebilizumab. Class I evidence from a randomized controlled trial supports the reduction of risk of attack in AQP4+ NMOSD by inebilizumab. CONCLUSION: Inebilizumab is an effective, first-line, on-label option for attack-preventive treatment of patients with AQP4+ NMOSD. It has not been established whether the efficacy of inebilizumab (anti-CD19) and rituximab (anti-CD20, off-label) for attack prevention in AQP4+ NMOSD differs. Due to missing head-to-head studies, the differential indication of inebilizumab versus three other approved maintenance treatment options for AQP4+ NMOSD is a matter of ongoing debate.
Keywords:	B-Cell Depletion, CD19, Inebilizumab, Neuromyelitis Optica Spectrum Disorder, NMOSD, Rituximab
Source:	touchREVIEWS in Neurology
ISSN:	2752-5465
Publisher:	Touch Medical Media
Volume:	20
Number:	1
Page Range:	16-22
Date:	2024
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