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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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“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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Self-citationEculizumab in Aquaporin-4–Positive Neuromyelitis Optica Spectrum Disorder
Pittock, S. J., Berthele, A., Fujihara, K., Kim, H. J., Levy, M., Palace, J. A., Nakashima, I., Terzi, M., Totolyan, N. A., Viswanathan, S., et al. (2019) · New England Journal of Medicine · doi:10.1056/nejmoa1900866 · Cited by 887
Self-citationAn open label study of the effects of rituximab in neuromyelitis optica
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Self-citationIntrathecal pathogenic anti–aquaporin‐4 antibodies in early neuromyelitis optica
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Self-citationNeuromyelitis optica IgG predicts relapse after longitudinally extensive transverse myelitis
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“in NMO patients (93% with AQP4 antibodies, the rest either MOG positive or double seronegative); in the 197 days of follow-up, only 12% of treated patients relapsed [85].”
BackgroundEngineering Cell Therapies for Autoimmune Diseases: From Preclinical to Clinical Proof of Concept
Oh, S., & Payne, A. S. (2022) · Immune Network · doi:10.4110/in.2022.22.e37 · Cited by 22
“In the N-Momentum double-blind randomized clinical trial (NCT02200770), 213 (93%) of the 230 NMOSD subjects were seropositive for AQP4 autoantibodies and were treated with either inebilizumab (n=174) or placebo (n=56) (58).”
BackgroundTkachuk, V. A., Aguirre, M. E. B., Alonso, R. N., Barboza, A. G., Liwacki, S., Mainella, C., Rojas, J. I., Silva, B. A., Tavolini, D., Zanga, G., et al. (2022) · Multiple Sclerosis and Related Disorders · doi:10.1016/j.msard.2022.104485 · Cited by 22
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“seropositive for MOG-IgG and may present with severe bilateral ON [31].”
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“These patients group was considered as aggressive NMOSD compare with the naïve NMOSD patients, who include as true placebo in other studies (6, 7).”
BackgroundResultTherapeutic tactics for targeting B lymphocytes in autoimmunity and cancer
Wemlinger, S. M., & Cambier, J. C. (2023) · European Journal of Immunology · doi:10.1002/eji.202249947 · Cited by 23
The Role of Chimeric Antigen Receptor T‐Cell Therapy in Immune‐Mediated Neurological Diseases
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BackgroundSelf-citationCurrent and emerging biologics for the treatment of neuromyelitis optica spectrum disorders
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Neuromyelitis Optica Spectrum Disorder: From Basic Research to Clinical Perspectives
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“The incidence of infusion-associated reactions was similar in NMOSD patients receiving inebilizumab or placebo (9% and 11%, respectively) in the N-MOmentum trial (38).”
BackgroundMethodResultInfluentialRisks and outcomes of pregnancy in neuromyelitis optica spectrum disorder: A comprehensive review
Siriratnam, P., Huda, S., Butzkueven, H., van der Walt, A., Jokubaitis, V., & Monif, M. (2023) · Autoimmunity Reviews · doi:10.1016/j.autrev.2023.103499 · Cited by 21
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Development of a CD19 PET tracer for detecting B cells in a mouse model of multiple sclerosis
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Neutropenia following immune-depletion, notably CD20 targeting, therapies in multiple sclerosis
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Microglia complement astrocytes in neuromyelitis optica
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Emerging drugs for the treatment of neuromyelitis optica
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Self-citationSensitivity analysis of the primary endpoint from the N-MOmentum study of inebilizumab in NMOSD
Cree, B., Bennett, J. L., Kim, H. J., Weinshenker, B. G., Pittock, S. J., Wingerchuk, D. M., Fujihara, K., Paul, F., Cutter, G., Marignier, R., et al. (2021) · Multiple Sclerosis Journal · doi:10.1177/1352458521988926 · Cited by 19
Self-citationEmerging drugs for the treatment of adult MOG-IgG-associated diseases
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“Besides, they did not demonstrate fewer AEs in the RCTs [14, 17].”
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Inebilizumab reduces neuromyelitis optica spectrum disorder risk independent of FCGR3A polymorphism
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Self-citationLi, Z., Xu, Q., Huang, J., Zhu, Q., Yang, X., Zhang, M., Zhang, S., Huang, S., Yu, G., Zheng, P., et al. (2024) · Heliyon · doi:10.1016/j.heliyon.2024.e30421 · Cited by 18
“Efgartigimod, compared to ineblizumab (a CD19 monoclonal antibody) [10] and satralizumab (an IL-6 monoclonal antibody) [11], demonstrates a more rapid onset of action.”
BackgroundNovel emerging treatments for NMOSD
Selmaj, K. W., & Selmaj, I. (2019) · Neurologia i Neurochirurgia Polska · doi:10.5603/pjnns.a2019.0049 · Cited by 19
“Inebilizumab was evaluated in a phase 3, double-blind, randomised, placebo-controlled trial (N-MOmentum) in 231 NMOSD patients, both AQP4 Ab-positive (91%) and AQP4 Ab-negative (9%) [49].”
MethodSatralizumab in the Treatment of Neuromyelitis Optica Spectrum Disorder
Duchow, A. S., & Bellmann–Strobl, J. (2020) · Neurodegenerative Disease Management · doi:10.2217/nmt-2020-0046 · Cited by 19
Ala, M., Jafari, R. M., Hajiabbasi, A., & Dehpour, A. R. (2021) · Journal of Cellular Physiology · doi:10.1002/jcp.30318 · Cited by 19
“…randomized, double‐blinded clinical trials demonstrated that Eculizumab (a monoclonal antibody for C5) and Inebilizumab (a humanized monoclonal antibody for CD19+ B cells) can decrease the risk of relapse in patients with AQP4‐IgG‐positive NMO (Cree et al., 2019; S. J. Pittock et al., 2019).”
BackgroundNew Therapeutic Landscape in Neuromyelitis Optica
Tugizova, M. S., Vlahovic, L., Tomczak, A. J., Wetzel, N. S., & Han, M. H. (2021) · Current Treatment Options in Neurology · doi:10.1007/s11940-021-00667-3 · Cited by 19
The balanced CEO: a transformational leader and a capable manager.
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The Clinical Trial Landscape in Autoimmune Encephalitis
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“Inebilizumab is a monoclonal antibody that can bind to CD19 and deplete CD19-expressing B cells, and has been shown as an effective and therapeutic option for the management of patients with neuromyelitis optica spectrum disorder [56,57].”
Approaches for Controlling Antibody-Mediated Allograft Rejection Through Targeting B Cells
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Immuno-pathogenesis of neuromyelitis optica and emerging therapies
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“patients with neuromyelitis optica spectrum disorders [81] and is under evaluation in MG in a phase 3 RCT (ClinicalTrials.”
BackgroundPediatric Neuromyelitis Optica Spectrum Disorder
Poisson, K. E., Moeller, K., & Fisher, K. S. (2023) · Seminars in Pediatric Neurology · doi:10.1016/j.spen.2023.101051 · Cited by 21
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“Accordingly, a phase I, placebo-controlled trial of inebilizumab (formerly MEDI-551, CD19+ B-cell depleting therapy) in 28 RRMS patients led to the further development of this treatment only for neuromyelitis optica spectrum disorder (N-Momentum trial [152]), although revealing”
ResultSecond-generation immunotherapeutics in multiple sclerosis: can we discard their precursors?
Findling, O., & Sellner, J. (2020) · Drug Discovery Today · doi:10.1016/j.drudis.2020.11.022 · Cited by 17
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Zhu, W., Zhang, Y., Wang, Z., Fu, Y., & Yan, Y. (2020) · Neuroscience Bulletin · doi:10.1007/s12264-020-00525-3 · Cited by 17
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Self-citationTreatment of myelin oligodendrocyte glycoprotein immunoglobulin G–associated disease
Healy, S., Elhadd, K. T., Gibbons, E. L., Whittam, D., Griffiths, M. J., Jacob, A., & Huda, S. (2021) · Clinical and Experimental Neuroimmunology · doi:10.1111/cen3.12630 · Cited by 17
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Self-citationWong, K., Day, G. S., Torner, J. C., Cudkowicz, M., Coffey, C. S., Cho, H. J., Utz, U., Clifford, D. B., Katz, E., Ratchford, J. N., et al. (2025) · Neurology Open Access · doi:10.1212/wn9.0000000000000007 · Cited by 16
Self-citationEmerging Role of Targeted Monoclonal Antibodies in Neuromyelitis Optica Spectrum Disorders
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Self-citationLevy, M., Haycox, A. R., Becker, U., Costantino, C., Damonte, E., Klingelschmitt, G., von Büdingen, H.-C., Wallenstein, G. V., Maio, D. D., & Szczechowski, L. (2021) · Multiple Sclerosis and Related Disorders · doi:10.1016/j.msard.2021.103332 · Cited by 16
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B cell and aquaporin‐4 antibody relationships with neuromyelitis optica spectrum disorder activity
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“4,15 Inebilizumab treatment substantially reduced CD20 + B cells, CD27 + memory B cells, na € ıve B cells, and PBs/ PCs. 10,13 Among placebo-treated participants, CD20 + B cells, PB/PC signature, and AQP4-IgG titers increased from baseline during attacks.”
BackgroundSelf-citationSingle-cell approaches to investigate B cells and antibodies in autoimmune neurological disorders
Zou, A., Ramanathan, S., Dale, R. C., & Brilot, F. (2020) · Cellular and Molecular Immunology · doi:10.1038/s41423-020-0510-z · Cited by 16
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Self-citationPathogenic antibodies to AQP4: Neuromyelitis optica spectrum disorder (NMOSD)
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Engineered immune cells as therapeutics for autoimmune diseases
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Novel strategies to target the humoral alloimmune response
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“In a phase 2/3 RCT, a humanized anti-CD19 monoclonal antibody, inebilizumab, significantly reduced autoantibodies and relapse rates in patients with neuromyelitis optica.(92) Tolerability and safety of this drug is currently being evaluated in highly sensitized patients awaiting kidney transplantation (NCT04174677).”
BackgroundB-Cell Targeted Treatments for Neuromyelitis Optica Spectrum Disorder: A Focus on CD19 and CD20
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Metadata
- 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 › Clinical Neurology › Multiple Sclerosis Research Studies
- Health Sciences › Medicine › Clinical 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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