Real-World Multicenter Cohort Study of Inebilizumab vs Low-Dose Rituximab in Neuromyelitis Optica Spectrum Disorders

BACKGROUND AND OBJECTIVES: Inebilizumab and rituximab (RTX) are anti-CD19 and anti-CD20 B cell-depleting antibodies, respectively. They are both used in the treatment of neuromyelitis optica spectrum disorders (NMOSD). However, limited data on both drugs exist regarding real-world clinical applications. This study aimed to assess the efficacy and safety of inebilizumab vs low-dose RTX in NMOSD patients through a retrospective-prospective multicenter analysis. METHODS: This study collected data on aquaporin-4 immunoglobulin G seropositive NMOSD patients from 6 cities in China among those receiving either inebilizumab or low-dose RTX (500 mg), with a 1-year follow-up. Analyses assessed outcomes using inverse probability of treatment weighting and doubly robust models. RESULTS: = 0.003). DISCUSSION: In this short-term study, inebilizumab demonstrated greater efficacy in reducing relapse risk, along with significantly lower rates of key adverse events, compared with low-dose RTX in patients with NMOSD. These findings support the use of inebilizumab as an effective and well-tolerated therapeutic option in a broader NMOSD population. CLASSIFICATION OF EVIDENCE: This short-term study with a 12-month observation period provides Class III evidence that in patients with NMOSD, inebilizumab is more effective than low-dose RTX in reducing relapses.