Real World Effectiveness and Tolerability of Novel Monoclonal Antibodies and Rituximab for NMOSD

ABSTRACT In this multicenter retrospective cohort study of 135 people with aquaporin‐4 IgG+ neuromyelitis optica spectrum disorder (NMOSD), some of whom were exposed to multiple therapies, we evaluated the effectiveness and tolerability of rituximab ( n = 111) and novel monoclonal antibodies (nMAbs): eculizumab ( n = 9), inebilizumab ( n = 23), and satralizumab ( n = 14). Over a median follow‐up of 3.92 years, 21/111 rituximab‐treated patients relapsed. In contrast, relapse occurred in only 1/23 inebilizumab‐treated patients (median follow‐up 1.27 years), with no relapses observed in those receiving eculizumab or satralizumab. Twelve‐month relapse‐free probabilities were 92% (rituximab), 94% (inebilizumab), and 100% (eculizumab and satralizumab). Among those with available MRI data, 10/73 rituximab and 1/14 inebilizumab developed new lesions. There were no serious adverse events. These findings support nMAbs as effective and well‐tolerated first‐line therapies for NMOSD.