1. International Delphi Consensus on the Management of AQP4-IgG+ NMOSD: Recommendations for Eculizumab, Inebilizumab, and Satralizumab.
- Author
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Paul, Friedemann, Marignier, Romain, Palace, Jacqueline, Arrambide, Georgina, Asgari, Nasrin, Bennett, Jeffrey L, Cree, Bruce Anthony Campbell, De Sèze, Jérôme, Fujihara, Kazuo, Kim, Ho Jin, Hornby, Rebecca, Huda, Saif, Kissani, Najib, Kleiter, Ingo, Kuwabara, Satoshi, Lana-Peixoto, Marco, Law, Lisa, Leite, M Isabel, Pandit, Lekha, Pittock, Sean J, Quan, Chao, Ramanathan, Sudarshini, Rotstein, Dalia, Saiz, Albert, Sato, Douglas Kazutoshi, and Vaknin-Dembinsky, Adi
- Subjects
Humans ,Neuromyelitis Optica ,Immunoglobulin G ,Consensus ,Delphi Technique ,Aquaporin 4 ,Clinical Research ,Good Health and Well Being - Abstract
Background and objectivesNeuromyelitis optica spectrum disorder (NMOSD) is a rare debilitating autoimmune disease of the CNS. Three monoclonal antibodies were recently approved as maintenance therapies for aquaporin-4 immunoglobulin G (AQP4-IgG)-seropositive NMOSD (eculizumab, inebilizumab, and satralizumab), prompting the need to consider best practice therapeutic decision-making for this indication. Our objective was to develop validated statements for the management of AQP4-IgG-seropositive NMOSD, through an evidence-based Delphi consensus process, with a focus on recommendations for eculizumab, inebilizumab, and satralizumab.MethodsWe recruited an international panel of clinical experts in NMOSD and asked them to complete a questionnaire on NMOSD management. Panel members received a summary of evidence identified through a targeted literature review and provided free-text responses to the questionnaire based on both the data provided and their clinical experience. Responses were used to generate draft statements on NMOSD-related themes. Statements were voted on over a maximum of 3 rounds; participation in at least 1 of the first 2 rounds was mandatory. Panel members anonymously provided their level of agreement (6-point Likert scale) on each statement. Statements that failed to reach a predefined consensus threshold (≥67%) were revised based on feedback and then voted on in the next round. Final statements were those that met the consensus threshold (≥67%).ResultsThe Delphi panel comprised 24 experts, who completed the Delphi process in November 2021 after 2 voting rounds. In round 1, 23/25 statements reached consensus and were accepted as final. The 2 statements that failed to reach consensus were revised. In round 2, both revised statements reached consensus. Twenty-five statements were agreed in total: 11 on initiation of or switching between eculizumab, inebilizumab, and satralizumab; 3 on monotherapy/combination therapy; 7 on safety and patient population considerations; 3 on biomarkers/patient-reported outcomes; and 1 on research gaps.DiscussionAn established consensus method was used to develop statements relevant to the management of AQP4-IgG-seropositive NMOSD. These international statements will be valuable for informing individualized therapeutic decision-making and could form the basis for standardized practice guidelines.
- Published
- 2023