Inebilizumab for the treatment of neuromyelitis optica spectrum disorder (N-MOmentum): a double-blind, randomised placebo-controlled phase 2/3 trial
Abstract
Background No approved therapies exist for neuromyelitis optica spectrum disorder (NMOSD), a rare, relapsing, autoimmune, inflammatory disease of the CNS that causes blindness and paralysis. We aimed to assess the efficacy and safety of inebilizumab, an anti-CD19, B cell-depleting antibody, in reducing the risk of attacks and disability in NMOSD. Methods We did a multicentre, double-blind, randomised placebo-controlled phase 2/3 study at 99 outpatient specialty clinics or hospitals in 25 countries. Eligible participants were adults (≥18 years old) with a diagnosis of NMOSD, an Expanded Disability Status Scale score of 8·0 or less, and a history of at least one attack requiring rescue therapy in the year before screening or at least two attacks requiring rescue therapy in the 2 years before screening. Participants were randomly allocated (3:1) to 300 mg intravenous inebilizumab or placebo with a central interactive voice response system or interactive web response system and permuted block randomisation. Inebilizumab or placebo was administered on days 1 and 15. Participants, investigators, and all clinical staff were masked to the treatments, and inebilizumab and placebo were indistinguishable in appearance. The primary endpoint was time to onset of an NMOSD attack, as determined by the adjudication committee. Efficacy endpoints were assessed in all randomly allocated patients who received at least one dose of study intervention, and safety endpoints were assessed in the as-treated population. The study is registered with ClinicalTrials.gov, number NCT02200770. Findings Between Jan 6, 2015, and Sept 24, 2018, 230 participants were randomly assigned to treatment and dosed, with 174 participants receiving inebilizumab and 56 receiving placebo. The randomised controlled period was stopped before complete enrolment, as recommended by the independent data-monitoring committee, because of a clear demonstration of efficacy. 21 (12%) of 174 participants receiving inebilizumab had an attack versus 22 (39%) of 56 participants receiving placebo (hazard ratio 0·272 [95% CI 0·150-0·496]; p<0·0001). Adverse events occurred in 125 (72%) of 174 participants receiving inebilizumab and 41 (73%) of 56 participants receiving placebo. Serious adverse events occurred in eight (5%) of 174 participants receiving inebilizumab and five (9%) of 56 participants receiving placebo. Interpretation Compared with placebo, inebilizumab reduced the risk of an NMOSD attack. Inebilizumab has potential application as an evidence-based treatment for patients with NMOSD. Funding MedImmune and Viela Bio.
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The long-term persistence of (re-)activatable autoantigen-specific ThEx cells in patients in remission may well explain the less-than-perfect treatment efficacy of steroid-sparing agents, depletion of CD19/CD20 memory B cells, as well as exacerbation of disease by b-IFN.
“In any case, the long-term persistence of (re-)activatable autoantigen-specific ThEx cells in patients in remission may well explain the less-than-perfect treatment efficacy of steroid-sparing agents, 64-67 depletion of CD19/CD20 memory B cells, 68,69 as well as exacerbation of disease by b -IFN. 27,70”
From Autoantigen-specific CD4+ T cells acquire an exhausted phenotype and persist in human antigen-specific autoimmune diseases (2024) · cites this paper as [68]
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“A number of monoclonal antibodies have recently been proven to be highly effective for relapse prevention in patients with AQP4 autoantibodies by randomized clinical trials, including eculizumab (anti-C5 complement protein) (142), satralizumab (anti-IL-6 receptor) (143), inebilizumab (antiCD19) (144), and the better-k…”
BackgroundNeuroinflammation: Mechanisms, Dual Roles, and Therapeutic Strategies in Neurological Disorders
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“Neurologic Inebilizumab Uplizna CD19 Humanized IgG1 Neuromyelitis optica and neuromyelitis optica spectrum disorders [391] 2020 2022”
BackgroundTime to Disability Milestones and Annualized Relapse Rates in NMOSD and MOGAD
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MOG CNS Autoimmunity and MOGAD
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“for the optimal selection of B cell–depleting agents for preventing disease relapse (77).”
BackgroundEvolution of Anti-B Cell Therapeutics in Autoimmune Neurological Diseases
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“22 of 56 (39%) in the placebo group [136].”
BackgroundTreatment regimens for neuromyelitis optica spectrum disorder attacks: a retrospective cohort study
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Self-citationStrategies for Glycoengineering Therapeutic Proteins
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Self-citationAdvances and challenges in the treatment of myasthenia gravis
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Treatment of Neuromyelitis Optica Spectrum Disorders
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“Inebulizumab is a humanized monoclonal antibody targeting CD19, and depletes CD19+ B cells, as well as CD19-expressing plasmablasts and plasma cells, which produce and secrete AQP4-IgG; it has B cell suppressive and anti-inflammatory effects, as well as an inhibitory effect on AQP4-IgG synthesis and secretion from ant…”
BackgroundMethodInfluentialMOGAD patient autoantibodies induce complement, phagocytosis, and cellular cytotoxicity
Yandamuri, S. S., Filipek, B., Obaid, A., Lele, N., Thurman, J. M., Makhani, N., Nowak, R. J., Guo, Y. X., Lucchinetti, C. F., Flanagan, E. P., et al. (2023) · JCI Insight · doi:10.1172/jci.insight.165373 · Cited by 60 · see citing works
“1) Sex, n (%) Female 6 (75%) 4 (100) 2 (50) 3 (60) Male 2 (25%) 0 (0) 2 (50) 2 (16) Unknown 0 (0) 0 (0) 0 (0) 1 (8) Treatment, n (%) Untreated 2 (25) 0 (0) 1 (20) Rituximab 0 (0) 2 (50) 1 (20) Steroids 4 (50) 3 (75) 1 (20) Mycophenolate mofetil 1 (12.”
Effectiveness of subcutaneous tocilizumab in neuromyelitis optica spectrum disorders
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Therapies in Stiff-Person Syndrome
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Autoimmune encephalitis: recent clinical and biological advances
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Defining immune reset: achieving sustained remission in autoimmune diseases
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“Consequently, it was developed for neuromyelitis optica spectrum disorder (NMOSD) 68 , a disease that is associated with aquaporin 4 (AQP4) autoantibodies 69 .”
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Self-citationDouble-negative neuromyelitis optica spectrum disorder
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“On the basis of the results of a randomised controlled phase 2/3 trial (N-MOmentum; NCT02200770) in neuromyelitis optica spectrum disorder (NMOSD), it has received regulatory approval for NMOSD in the USA and Japan in 2020 [102, 103].”
Myasthenia gravis in 2025: five new things and four hopes for the future
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“1), anti-CD19 therapy, now in use in neuromyelitis spectrum disorder, may offer the chance to deplete resistant cells [56].”
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“(a) Inebilizumab, a monoclonal anti-CD19 antibody approved in neuromyelitis optica [73, 74].”
BackgroundUpdate on neuromyelitis optica spectrum disorder
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Altered fovea in AQP4-IgG–seropositive neuromyelitis optica spectrum disorders
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Self-citationB-Cell Compartmental Features and Molecular Basis for Therapy in Autoimmune Disease
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Monoclonal Antibody Therapies Beyond Complement for NMOSD and MOGAD
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“Evidence N‐MOmentum Trial Design N-MOmentum is a multicenter, double-blind, randomized placebo-controlled, phase 2/3 trial for inebilizumab published in 2019 [110].”
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Cytokine dynamics and targeted immunotherapies in autoimmune encephalitis
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- Authors
- Cree, B. A. C., Bennett, J. L., Kim, H. J., Weinshenker, B. G., Pittock, S. J., Wingerchuk, D. M., Fujihara, K., Paul, F., Cutter, G. R., Marignier, R., Green, A. J., Aktas, O., Hartung, H.-P., Lublin, F. D., Drappa, J., Barron, G., Madani, S., Ratchford, J. N., She, D., Cimbora, D., & Katz, E.
- Affiliations
- University of California, San Francisco (US)
- University of Colorado Anschutz (US)
- National Cancer Center (KR)
- Mayo Clinic (US)
- Mayo Clinic in Arizona (US)
- Fukushima Medical University (JP)
- Max Delbrück Center (DE)
- University of Alabama at Birmingham (US)
- Hospices Civils de Lyon (FR)
- Heinrich Heine University Düsseldorf (DE)
- Icahn School of Medicine at Mount Sinai (US)
- Corresponding author
- Cree, Bruce A C
- ORCID
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2019-10
- Volume
- 394
- Issue
- 10206
- Pages
- 1352-1363
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- OpenAlex
- W2972221943
- Cited by
- 756
- References
- 26
- Citations by year
- 2026: 105 · 2025: 118 · 2024: 102 · 2023: 101 · 2022: 102 · 2021: 117 · 2020: 101 · 2019: 7
- FWCI
- 58.77
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Lancet (publishedVersion)
- PubMed (publishedVersion)
- MDC Repository (Max-Delbrueck-Center for Molecular Medicine) (submittedVersion)
- Funders
- Hospices Civils de Lyon
- Topics
- Health Sciences › Medicine › Pathology and Forensic Medicine › Multiple Sclerosis Research Studies
- Health Sciences › Medicine › Neurology › Peripheral Neuropathies and Disorders
- Health Sciences › Medicine › Ophthalmology › Ocular Diseases and Behçet’s Syndrome
- Keywords
- neuromyelitis optica spectrum disorder, inebilizumab, anti-CD19, B-cell depletion, relapse prevention, disability progression, Expanded Disability Status Scale, treatment-emergent adverse events, autoimmune CNS disease, treatment efficacy and safety, relapse-free survival
- MeSH terms
- Adolescent, Adult, Aged, Double-Blind Method, Female, Hospitalization, Humans, Male, Middle Aged, Neuromyelitis Optica, Prospective Studies, Severity of Illness Index, Treatment Outcome, Young Adult, Antibodies, Monoclonal, Humanized
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