Recently, 3 innovative, safe, and effective biologic medicines for neuromyelitis optica spectrum disorder (NMOSD) have been available, creating a difficult decision-making process for both doctors and patients. In NMOSD patients who test positive for aquaporin-4 antibody (AQP4+), inebilizumab (a CD19-targeted B cell depletion therapy) and satralizumab (a blocker of the IL-6 pathway) are recommended treatments. A comprehensive and thorough trial comparison was provided by a Matching-Adjusted Indirect Comparison (MAIC) analysis to help in making a therapeutic choice based on evidence. The relative effectiveness of inebilizumab and satralizumab is compared here. N-MOmentum (NCT02200770; N=161) and SAkuraStar (NCT02073279; N=41) were both registrational monotherapy trials for inebilizumab and satralizumab, respectively. Therefore their data were reviewed to ensure the cross-study comparison was fair and accurate. Time to first adjudicated attack was used as the main endpoint in both studies, which were placebo-controlled and used equivalent evaluations and outcomes. A comprehensive MAIC analysis was conducted to compare the 2 investigations and draw conclusions about the prognostic importance of the AQP4+ population. About 7 factors were analyzed: sex, age, race, ethnicity, area, EDSS at baseline, and history of attacks. Differences in sex, race, and geographical location were shown to be the most important factors in explaining the differences between the 2 groups studied. Time to first adjudicated attack was used as the main effectiveness objective, and both inebilizumab and satralizumab met this target with uncorrected hazard ratios (HRs) of 0.227 and 0.260, respectively (each vs. placebo; statistically significant). After adjusting the N-MOmentum trial population to be more similar to that of SAkuraStar (using the MAIC analysis), the HR for inebilizumab decreased from 0.227 to 0.174. When comparing inebilizumab to satralizumab, the relative risk ratio for inebilizumab was 0.67, indicating that inebilizumab was 33% more effective than satralizumab for the main objective. Thus, it may be estimated that inebilizumab-treated individuals would have 67.3 fewer attacks than satralizumab-treated ones. Many sensitivity studies reaffirmed the reliability of this outcome. While it is true that comparing data from different studies has its limits, these findings do show that inebilizumab is more effective than satralizumab at preventing NMOSD attacks.
Reference: ECTRIMS 2022
