Interleukin-6 Receptor Blockade in Treatment-Refractory MOG-IgG-Associated Disease and Neuromyelitis Optica Spectrum Disorders.
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Ringelstein Marius, Ayzenberg Ilya, Lindenblatt Gero, Fischer Katinka, Gahlen Anna, Novi Giovanni, Hayward-Könnecke Helen, Schippling Sven, Rommer Paulus S, Kornek Barbara, Zrzavy Tobias, Biotti Damien, Ciron Jonathan, Audoin Bertrand, Berthele Achim, Giglhuber Katrin, Zephir Helene, Kümpfel Tania, Berger Robert, Röther Joachim, Häußler Vivien, Stellmann Jan-Patrick, Whittam Daniel, Jacob Anu, Kraemer Markus, Gueguen Antoine, Deschamps Romain, Bayas Antonios, Hümmert Martin W, Trebst Corinna, Haarmann Axel, Jarius Sven, Wildemann Brigitte, Grothe Matthias, Siebert Nadja, Ruprecht Klemens, Paul Friedemann, Collongues Nicolas, Marignier Romain, Levy Michael, Karenfort Michael, Deppe Michael, Albrecht Philipp, Hellwig Kerstin, Gold Ralf, Hartung Hans-Peter, Meuth Sven G, Kleiter Ingo, Aktas Orhan, Neuromyelitis Optica Study Group (NEMOS)
Аннотация
METHODS: Annualized relapse rate (ARR), Expanded Disability Status Scale score, MRI, autoantibody titers, pain, and adverse events were retrospectively evaluated in 57 patients with MOGAD (n = 14), aquaporin-4 (AQP4)-IgG seropositive (n = 36), and seronegative NMOSD (n = 7; 12%), switched to TCZ from previous immunotherapies, particularly rituximab.
RESULTS: Patients received TCZ for 23.8 months (median; interquartile range 13.0-51.1 months), with an IV dose of 8.0 mg/kg (median; range 6-12 mg/kg) every 31.6 days (mean; range 26-44 days). For MOGAD, the median ARR decreased from 1.75 (range 0.5-5) to 0 (range 0-0.9; p = 0.0011) under TCZ. A similar effect was seen for AQP4-IgG+ (ARR reduction from 1.5 [range 0-5] to 0 [range 0-4.2]; p < 0.001) and for seronegative NMOSD (from 3.0 [range 1.0-3.0] to 0.2 [range 0-2.0]; p = 0.031). During TCZ, 60% of all patients were relapse free (79% for MOGAD, 56% for AQP4-IgG+, and 43% for seronegative NMOSD). Disability follow-up indicated stabilization. MRI inflammatory activity decreased in MOGAD (p = 0.04; for the brain) and in AQP4-IgG+ NMOSD (p < 0.001; for the spinal cord). Chronic pain was unchanged. Regarding only patients treated with TCZ for at least 12 months (n = 44), ARR reductions were confirmed, including the subgroups of MOGAD (n = 11) and AQP4-IgG+ patients (n = 28). Similarly, in the group of patients treated with TCZ for at least 12 months, 59% of them were relapse free, with 73% for MOGAD, 57% for AQP4-IgG+, and 40% for patients with seronegative NMOSD. No severe or unexpected safety signals were observed. Add-on therapy showed no advantage compared with TCZ monotherapy.
DISCUSSION: This study provides Class III evidence that long-term TCZ therapy is safe and reduces relapse probability in MOGAD and AQP4-IgG+ NMOSD.