All NMOSD treatments can lower the risk of attacks. But what about complications of NMOSD and other treatment considerations, such as worsening disability, hospitalizations, or time lost to frequent dosing?

Only UPLIZNA delivers the combination of protection beyond attacks, an established safety profile, and twice-yearly dosing.1-3a

UPLIZNA delivered significant protection from attacks, with a 77% relative risk reduction vs placebo; at 6 months, 11% of patients on UPLIZNA and 42% on placebo experienced an attack (HR=0.227 [95% CI: 0.121-0.423], P<0.0001); the annualized rate of hospitalization was 0.11 for UPLIZNA vs 0.50 for placebo (a 78% relative risk reduction [P=0.017]); the percentage of patients with worsening disability from baseline was 15% for UPLIZNA vs 35% for placebo (a 57% relative risk reduction [P=0.0047]).2bc

The EDSS analysis included visits during an attack, with EDSS progression driven by the expected increase in EDSS at the time of attack. Therefore, these results should not be interpreted as impacting disability independent of attack reduction. Additionally, subjects were not followed up for the same amount of time, resulting in missing data which may have introduced biases into the analysis. Subjects with missing data are imputed as worsening.

Proven
attack reduction2

Attack Reduction

Established
safety profile2

Safety

Twice-yearly
monotherapy2a

Dosing Information

aTwice-yearly dosing occurs after 2 initial doses.2

bN-MOmentum was a phase 2/3, multicenter, double-blind, randomized (3:1), placebo-controlled trial with an OLP. The RCP included 213 AQP4-IgG+ patients (UPLIZNA n=161; placebo n=52) and 17 AQP4-IgG negative patients. The primary efficacy endpoint was the time to the onset of the first adjudicated relapse on or before Day 197.2

cWorsening disability was assessed by the EDSS at last visit during the RCP, defined as 1) worsening of 2 or more points in EDSS score for subjects with baseline score of 0; (2) worsening of 1 or more points in EDSS score for subjects with baseline score of 1 to 5; (3) or worsening of 0.5 points or more in EDSS score for subjects with baseline score of 5.5 or more.4

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A panel of international experts agreed inebilizumab was the only treatment to receive 100% consensus recommendation for initiation at diagnosis, after first attack, or after relapse due to failure of existing treatments in adults with AQP4-IgG+ NMOSD.5d

See additional consensus statements

dThe NMOSD Delphi Panel was convened to develop validated recommendations on the treatment of AQP4-IgG+ patients with NMOSD. This international panel of clinical experts drafted consensus statements regarding therapy initiation, monotherapy vs combination therapy, switching therapies, patient populations, safety, use of biomarkers and patient-reported outcomes, and gaps in research. Of those 18 panelists, 14 agreed on the same initiation criteria for eculizumab, and 17 for satralizumab. Each therapy met the panel’s predefined consensus threshold (67% or greater).5

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AQP4-IgG+, aquaporin-4-immunoglobulin G positive; EDSS, Expanded Disability Status Scale; HR, hazard ratio; NMOSD, neuromyelitis optica spectrum disorder; OLP, open-label period; RCP, randomized controlled period.

Tx Recommendations

INDICATION AND IMPORTANT SAFETY INFORMATION

INDICATION

UPLIZNA (inebilizumab-cdon) is indicated for the treatment of neuromyelitis optica spectrum disorder (NMOSD) in adult patients who are anti-aquaporin-4 (AQP4) antibody positive.

IMPORTANT SAFETY INFORMATION

UPLIZNA is contraindicated in patients with:

  • A history of life-threatening infusion reaction to UPLIZNA
  • Active hepatitis B infection
  • Active or untreated latent tuberculosis

WARNINGS AND PRECAUTIONS

Infusion Reactions: UPLIZNA can cause infusion reactions, which can include headache, nausea, somnolence, dyspnea, fever, myalgia, rash, or other symptoms. Infusion reactions were most common with the first infusion but were also observed during subsequent infusions. Administer pre-medication with a corticosteroid, an antihistamine, and an anti-pyretic.

Infections: The most common infections reported by UPLIZNA-treated patients in the randomized and open-label periods included urinary tract infection (20%), nasopharyngitis (13%), upper respiratory tract infection (8%), and influenza (7%). Delay UPLIZNA administration in patients with an active infection until the infection is resolved.

Increased immunosuppressive effects are possible if combining UPLIZNA with another immunosuppressive therapy.

The risk of Hepatitis B Virus (HBV) reactivation has been observed with other B-cell-depleting antibodies. Perform HBV screening in all patients before initiation of treatment with UPLIZNA. Do not administer to patients with active hepatitis.

Although no confirmed cases of Progressive Multifocal Leukoencephalopathy (PML) were identified in UPLIZNA clinical trials, JC virus infection resulting in PML has been observed in patients treated with other B-cell-depleting antibodies and other therapies that affect immune competence. At the first sign or symptom suggestive of PML, withhold UPLIZNA and perform an appropriate diagnostic evaluation.

Patients should be evaluated for tuberculosis risk factors and tested for latent infection prior to initiating UPLIZNA.

Vaccination with live-attenuated or live vaccines is not recommended during treatment and after discontinuation, until B-cell repletion.

Reduction in Immunoglobulins: There may be a progressive and prolonged hypogammaglobulinemia or decline in the levels of total and individual immunoglobulins such as immunoglobulins G and M (IgG and IgM) with continued UPLIZNA treatment. Monitor the level of immunoglobulins at the beginning, during, and after discontinuation of treatment with UPLIZNA until B-cell repletion especially in patients with opportunistic or recurrent infections.

Fetal Risk: May cause fetal harm based on animal data. Advise females of reproductive potential of the potential risk to a fetus and to use an effective method of contraception during treatment and for 6 months after stopping UPLIZNA.

Adverse Reactions: The most common adverse reactions (at least 10% of patients treated with UPLIZNA and greater than placebo) were urinary tract infection and arthralgia.

Please see Full Prescribing Information for more information.

INDICATION AND IMPORTANT SAFETY INFORMATION

INDICATION

UPLIZNA (inebilizumab-cdon) is indicated for the treatment of neuromyelitis optica spectrum disorder (NMOSD) in adult patients who are anti-aquaporin-4 (AQP4) antibody positive.

IMPORTANT SAFETY INFORMATION

UPLIZNA is contraindicated in patients with:

  • A history of life-threatening infusion reaction to UPLIZNA
  • Active hepatitis B infection
  • Active or untreated latent tuberculosis

WARNINGS AND PRECAUTIONS

Infusion Reactions: UPLIZNA can cause infusion reactions, which can include headache, nausea, somnolence, dyspnea, fever, myalgia, rash, or other symptoms. Infusion reactions were most common with the first infusion but were also observed during subsequent infusions. Administer pre-medication with a corticosteroid, an antihistamine, and an anti-pyretic.

Infections: The most common infections reported by UPLIZNA-treated patients in the randomized and open-label periods included urinary tract infection (20%), nasopharyngitis (13%), upper respiratory tract infection (8%), and influenza (7%). Delay UPLIZNA administration in patients with an active infection until the infection is resolved.

Increased immunosuppressive effects are possible if combining UPLIZNA with another immunosuppressive therapy.

The risk of Hepatitis B Virus (HBV) reactivation has been observed with other B-cell-depleting antibodies. Perform HBV screening in all patients before initiation of treatment with UPLIZNA. Do not administer to patients with active hepatitis.

Although no confirmed cases of Progressive Multifocal Leukoencephalopathy (PML) were identified in UPLIZNA clinical trials, JC virus infection resulting in PML has been observed in patients treated with other B-cell-depleting antibodies and other therapies that affect immune competence. At the first sign or symptom suggestive of PML, withhold UPLIZNA and perform an appropriate diagnostic evaluation.

Patients should be evaluated for tuberculosis risk factors and tested for latent infection prior to initiating UPLIZNA.

Vaccination with live-attenuated or live vaccines is not recommended during treatment and after discontinuation, until B-cell repletion.

Reduction in Immunoglobulins: There may be a progressive and prolonged hypogammaglobulinemia or decline in the levels of total and individual immunoglobulins such as immunoglobulins G and M (IgG and IgM) with continued UPLIZNA treatment. Monitor the level of immunoglobulins at the beginning, during, and after discontinuation of treatment with UPLIZNA until B-cell repletion especially in patients with opportunistic or recurrent infections.

Fetal Risk: May cause fetal harm based on animal data. Advise females of reproductive potential of the potential risk to a fetus and to use an effective method of contraception during treatment and for 6 months after stopping UPLIZNA.

Adverse Reactions: The most common adverse reactions (at least 10% of patients treated with UPLIZNA and greater than placebo) were urinary tract infection and arthralgia.

Please see Full Prescribing Information for more information.

  1. Bennett JL, Aktas O, Rees WA, et al. Association between B-cell depletion and attack risk in neuromyelitis optica spectrum disorder: an exploratory analysis from N-MOmentum, a double-blind, randomised, placebo-controlled, multicentre phase 2/3 trial. EBioMedicine. 2022;86(104321):1-19. doi:10.1016/j.ebiom.2022.104321
  2. UPLIZNA (inebilizumab-cdon) [prescribing information] Horizon.
  3. Data on File. Horizon, June 2020.
  4. Cree BAC, Bennett JL, Kim HJ, et al. lnebilizumab for the treatment of neuromyelitis optica spectrum disorder (N-MOmentum): a double-blind, randomised placebo-controlled phase 2/3 trial. Lancet. 2019;394(10206):1352-1363. doi:10.1016/S0140-6736(19)31817-3
  5. Paul F, Marignier R, Palace J, et al. International Delphi Consensus on the management of AQP4-IgG+ NMOSD: recommendations for eculizumab, inebilizumab, and satralizumab. Neurol Neuroimmunol Neuroinflamm. 2023;10(4):e200124. doi:10.1212/NXl.0000000000200124