Long-Term Eculizumab in AQP4+ NMOSD: Relapse-Risk Reduction and Safety in PREVENT and its Completed Open-Label Extension. (5th December 2022)

• Record Type: Journal Article
• Authors: Berthele, Achim; Wingerchuk, Dean; Fujihara, Kazuo; Palace, Jacqueline; Levy, Michael; Kim, Ho Jin; Nakashima, Ichiro; Oreja-Guevara, Celia; Wang, Kai-Chen; Shang, Shulian; Yountz, Marcus; Pittock, Sean
• Is Part Of: Neurology. Volume 99:Number 23(2022)Supplement 2
• Page Start: S3
• Page End: S4
• Publication Date: 2022-12-05
• Subjects: Neurology -- Periodicals; Neurology -- Periodicals; Neurologie -- Périodiques; 616.8
• DOI: 10.1212/01.wnl.0000903068.75712.b8
• Languages: English
• ISSNs: 0028-3878

Abstract

Abstract : Objective: NA. Background: Eculizumab is well tolerated and significantly reduces relapse risk versus placebo in patients with aquaporin-4 immunoglobulin G-positive (AQP4+) neuromyelitis optica spectrum disorder (NMOSD). We report eculizumab's long-term relapse-risk-reduction efficacy and safety in AQP4+ NMOSD during PREVENT (NCT01892345) and its completed open-label extension (OLE; NCT02003144). Design/Methods: After receiving eculizumab or placebo during PREVENT, adults with AQP4+ NMOSD could enter the OLE (eculizumab maintenance dose, 1200 mg/2 weeks, with/without concomitant immunosuppressive therapy). Combined PREVENT and OLE (final data cut, 12 July 2021) data were analysed. Results: During PREVENT and/or the OLE, 137 patients received eculizumab for a median (range) of 183.4 (0.1–342.0) weeks (3.5 years) and a total of 449.2 patient-years (Table 1). The estimated proportion of adjudicated relapse-free patients at week 216 (4.1 years) was 92.9% (95% CI: 85.9–96.5%; Figure). Nine patients experienced 10 adjudicated relapses (seven during the OLE, including one since the last interim analysis; Table 2). The adjudicated annualized relapse rate was 0.022 (95% CI: 0.012–0.041; Table 1). Rates of treatment-related adverse events and serious adverse events (SAEs)/100 patient-years were 165.3 and 7.0, respectively, versus 167.5 and 24.5 with placebo in PREVENT. The most common SAE was urinary tract infection (5.1% of patients). The serious infection rate was 10.5/100 patient-years with no meningococcal infections. No patients died during the OLE. Conclusions: The proportion of relapse-free patients remained high (92.9%) through 4.1 years' eculizumab treatment. Long-term eculizumab was well tolerated with no new safety signals. These long-term data confirm eculizumab's sustained benefit/risk profile in AQP4+ NMOSD.