John Nevin, Lim Andy, Sunthar Shevita Ram, Zhang Leon, Cheng Joan, Boktor Julie, Chong Victor, Ma Henry, Phan Thanh G
Department of Medicine, School of Clinical Sciences, Monash University, 246 Clayton Road, Clayton, VIC, Australia.
Department of Neurology, Monash Health, Melbourne, VIC, Australia.
J Neurol. 2025 Aug 8;272(9):563. doi: 10.1007/s00415-025-13279-7.
There are numerous immunotherapies that are effective in preventing relapses in neuromyelitis optica spectrum disorder (NMO-SD). With head-to-head clinical trials between immunotherapies lacking, Bayesian network meta-analysis can be used to compare treatment interventions. Previous network meta-analyses have compared monoclonal antibodies but either not included newer complement inhibitors or earlier immunotherapies such as rituximab or tocilizumab.
To compare immunosuppressive treatments used in relapse prevention in NMO-SD.
PubMed, EMBASE and Scopus were searched for randomised controlled trials until 20th September, 2024. Search terms strategy included neuromyelitis optica, antibody and relapse. Randomised controlled trials testing immunotherapies used in relapse reduction in NMO-SD were included. Of 550 studies screened, 8 clinical trials initially met inclusion criteria. The study was performed according to PRISMA guidelines by multiple observers. Bayesian fixed-effect network meta-analysis was conducted. The primary outcome was time to relapse. The secondary outcome was annualised relapse rate. Sensitivity analysis was undertaken in seropositive patients. Treatments were ranked using a probability measure called surface under the cumulative rank curve (SUCRA).
Eight studies were included that contained a total 851 patients [716 (84%) seropositive]. There were six treatment interventions-ravulizumab, eculizumab, tocilizumab, rituximab, inebilizumab, satralizumab and the control arm (placebo/azathioprine). Ravulizumab was the ideal treatment (HR 0.00 (95%CrI 0.00-0.03), SUCRA 0.99) with a 98% probability of being the superior treatment in increasing time to relapse in NMO-SD. This was supported by secondary analysis of annualised relapse rate and the sensitivity analysis in seropositive patients.
These findings suggest that ravulizumab had the highest probability of being the most superior treatment in decreasing relapse risk in NMO-SD.
有多种免疫疗法可有效预防视神经脊髓炎谱系障碍（NMO-SD）的复发。由于缺乏免疫疗法之间的头对头临床试验，贝叶斯网络荟萃分析可用于比较治疗干预措施。以往的网络荟萃分析比较了单克隆抗体，但未纳入较新的补体抑制剂或诸如利妥昔单抗或托珠单抗等早期免疫疗法。
比较用于预防NMO-SD复发的免疫抑制治疗。
检索PubMed、EMBASE和Scopus数据库，查找截至2024年9月20日的随机对照试验。检索词策略包括视神经脊髓炎、抗体和复发。纳入测试用于降低NMO-SD复发率的免疫疗法的随机对照试验。在筛选的550项研究中，8项临床试验最初符合纳入标准。该研究由多名观察者按照PRISMA指南进行。进行了贝叶斯固定效应网络荟萃分析。主要结局是复发时间。次要结局是年化复发率。对血清阳性患者进行了敏感性分析。使用一种称为累积排序曲线下面积（SUCRA）的概率度量对治疗进行排序。
纳入8项研究，共851例患者[716例（84%）血清阳性]。有六种治疗干预措施——ravulizumab、依库珠单抗、托珠单抗、利妥昔单抗、inebilizumab、萨特利珠单抗以及对照组（安慰剂/硫唑嘌呤）。Ravulizumab是理想的治疗方法（HR 0.00（95%CrI 0.00 - 0.03），SUCRA 0.99），在增加NMO-SD复发时间方面有98%的概率成为最佳治疗方法。年化复发率的二次分析和血清阳性患者的敏感性分析支持了这一点。
这些发现表明，ravulizumab在降低NMO-SD复发风险方面最有可能是最佳治疗方法。
