FDA Approved Treatments for Neuromyelitis Optica Spectrum Disorder in Clinical Practice: A Survey of Academic Neuroimmunologists. (5th December 2022)

• Record Type: Journal Article
• Authors: Thon, Jesse; Sharkus, Robert; Thakkar, Richa; Hunter, Krystal; Siegler, James; Thon, Olga
• Is Part Of: Neurology. Volume 99:Number 23(2022)Supplement 2
• Page Start: S2
• Page End: S2
• Publication Date: 2022-12-05
• Subjects: Neurology -- Periodicals; Neurology -- Periodicals; Neurologie -- Périodiques; 616.8
• DOI: 10.1212/01.wnl.0000903060.69682.6b
• Languages: English
• ISSNs: 0028-3878

Abstract

Abstract : Objective: To assess utilization and barriers to use of three recently FDA-approved treatments for neuromyelitis optica spectrum disorder (NMOSD) by academic neuroimmunologists. Background: Since 2019, eculizumab, inebilizumab, and satralizumab have received FDA approval for the treatment of aquaporin-4 IgG positive (AQP4+) NMOSD after showing efficacy in reducing attack frequency. However, little is known regarding the adoption of these therapies into practice or barriers to their use. We conducted a survey of academic neuroimmunologists to identify current treatment practices. Design/Methods: An electronic survey study was conducted of US neuroimmunologists. Recipients were identified on department websites of university-associated hospitals with affiliated neurology residencies. The survey was administered via email, and included questions regarding clinical background, patient cohort, treatment use in different scenarios, and barriers. The authors were blinded to the identity of respondents. Results: 383 neuroimmunologists from 105 institutions were identified, of whom 33 from 18 states completed the survey. Nearly all (88%) reported treating patients with the newly FDA-approved therapies (NFTs). None reported discomfort discussing any NFT with their patients. Respondents reported uncommonly switching clinically stable patients to NFTs (69% never switch, 22% switch 1-25% of the time). For newly diagnosed AQP4+ NMOSD patients, NFT initiation rates varied (16% initiate none, 42% 1-25% of the time, 6.5% 25-50%, 19% 50-75%, 16% 75-100%). For patients with a relapse, responses were dichotomized regarding switching to NFTs - respondents either switch 75-100% of their patients (60%) or none or 1-25% (16%, 24% respectively). Nearly half (16/33) of respondents reported being unable to start NFTs, with insurance/cost issues being the most cited barrier. Conclusions: Among academic neuroimmunologists, FDA-approved therapies for AQP4+ NMOSD are being utilized for newly diagnosed patients and those with disease recurrence, although individual practice patterns vary. The main perceived barriers to NFT use are insurance/cost-related issues.