Why carry out this study?

Three drugs (eculizumab, inebilizumab, and satralizumab) are currently approved by the U.S. Food and Drug Administration for the treatment of adults with aquaporin-4 immunoglobulin G-positive neuromyelitis optica spectrum disorder (AQP4+ NMOSD).

In the absence of head-to-head clinical trials, we conducted a systematic literature review to identify data from randomized controlled trials (RCTs) for eculizumab, inebilizumab, and satralizumab and then performed an indirect treatment comparison of their efficacy via a fixed-effects Bayesian network meta-analysis (NMA).

What was learned from this study?

We found 29 publications from four unique RCTs (N-MOmentum, PREVENT, SAkuraSky, and SAkuraStar); the only efficacy outcome that could be evaluated in the NMA was time-to-first relapse, because it was the only outcome shared across all RCTs in AQP4+ NMOSD.

Hazard ratios suggest that patients on eculizumab monotherapy were 90% and 89% less likely to relapse when compared with patients on satralizumab or inebilizumab monotherapy, respectively; in all three treatment-setting scenarios tested (combined mono- and combination therapy, monotherapy, and combination therapy), eculizumab had the greatest likelihood of being the best treatment option for delaying time-to-first relapse in adults with AQP4+ NMOSD.

Our results suggest that complement component 5 (C5) inhibition may prevent NMOSD relapses more effectively than treatments with broader mechanisms of action, such as those targeting the interleukin-6 receptor or the B-cell surface antigen cluster of differentiation 19 (CD19).