Eculizumab in Asian patients with anti-aquaporin-IgG-positive neuromyelitis optica spectrum disorder: A subgroup analysis from the randomized phase 3 PREVENT trial and its open-label extension.

Abstract

Background Eculizumab, a terminal complement inhibitor, significantly reduced the risk of relapse compared with placebo in patients with anti-aquaporin-4 immunoglobulin G-positive (AQP4+) neuromyelitis optica spectrum disorder (NMOSD) in the PREVENT trial. We report efficacy and safety analyses in Asian patients in PREVENT and its open-label extension (OLE). Methods PREVENT was a double-blind, randomized, phase 3 trial. Patients with AQP4+ NMOSD were randomly assigned (2:1) to receive intravenous eculizumab (maintenance dose, 1200 mg/2 weeks) or placebo. Patients who completed PREVENT could receive eculizumab in an OLE. Analyses were performed in a prespecified subgroup of Asian patients. Results Of 143 patients enrolled, 52 (36.4%) were included in the Asian subgroup (eculizumab, n = 37; placebo, n = 15); 45 Asian patients received eculizumab in the OLE. Most Asian patients (86.5%) received concomitant immunosuppressive therapy. During PREVENT, one adjudicated relapse occurred in patients receiving eculizumab and six occurred in patients receiving placebo in the Asian subgroup (hazard ratio, 0.05; 95% confidence interval: 0.01-0.35; p = 0.0002). An estimated 95.2% of Asian patients remained relapse-free after 144 weeks of eculizumab treatment. Upper respiratory tract infections, headache, and nasopharyngitis were the most common adverse events with eculizumab in the Asian subgroup. Conclusion Eculizumab reduces the risk of relapse in Asian patients with AQP4+ NMOSD, with a benefit-risk profile similar to the overall PREVENT population. The benefits of eculizumab were maintained during long-term therapy. Clinical trial registration ClinicalTrials.gov identifiers: NCT01892345 (PREVENT); NCT02003144 (open-label extension).

• Authors: Ho Jin Kim, Ichiro Nakashima, Shanthi Viswanathan, Kai-Chen Wang, Shulian Shang, Larisa Miller, Marcus Yountz, Dean M Wingerchuk, Sean J Pittock, Michael Levy, Achim Berthele, Natalia Totolyan, Jacqueline Palace, Michael H Barnett, Kazuo Fujihara, PREVENT Study Group
• Journal: Multiple sclerosis and related disorders (Mult Scler Relat Disord) Vol. 50 Pg. 102849 (May 2021) ISSN: 2211-0356 [Electronic] Netherlands
• PMID: 33676197 (Publication Type: Clinical Trial, Phase III, Journal Article, Randomized Controlled Trial)
• Copyright: Copyright © 2021. Published by Elsevier B.V.

Chemical References

• Antibodies, Monoclonal, Humanized
• Aquaporin 4
• Immunoglobulin G
• eculizumab

Topics

• Antibodies, Monoclonal, Humanized
• Aquaporin 4
• Humans
• Immunoglobulin G
• Neuromyelitis Optica (drug therapy)