AUTHOR=Xue Tao , Yu Jiahao , Chen Shujun , Wang Zilan , Yang Yanbo , Chen Zhouqing , Wang Zhong 

TITLE=Different Targets of Monoclonal Antibodies in Neuromyelitis Optica Spectrum Disorders: A Meta-Analysis Evidenced From Randomized Controlled Trials

JOURNAL=Frontiers in Neurology

VOLUME=11

YEAR=2020

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2020.604445

DOI=10.3389/fneur.2020.604445

ISSN=1664-2295

ABSTRACT=<p><bold>Background:</bold> Neuromyelitis optica spectrum disorder (NMOSD), an autoimmune inflammatory disorder of the central nervous system, often leads to vision loss or paralysis. This meta-analysis focused on the assessment of the monoclonal antibody therapy in NMOSD and compared different targets of monoclonal antibodies with each other in terms of efficacy and safety outcomes.</p><p><bold>Method:</bold> We searched through the databases of MEDLINE, EMBASE, Central Register of Controlled Trials (CENTRAL), and clinicaltrials.gov for randomized controlled trials (RCTs) evaluating monoclonal antibody therapy in NMOSD up to April 2020.</p><p><bold>Results:</bold> We identified seven randomized controlled trials (RCTs), including 775 patients (monoclonal antibody group, <italic>n</italic> = 485 and placebo group, <italic>n</italic> = 290). Monoclonal antibody therapy decreased relapse risk (RR 0.33, 95% CI 0.21–0.52, <italic>P</italic> &lt; 0.00001), annualized relapse rate (ARR) (mean −0.28, 95% CI −0.35−0.20, <italic>P</italic> &lt; 0.00001), expanded disability status scale score (EDSS) (mean −0.19, 95% CI −0.32−0.07, <italic>P</italic> = 0.002) and serious adverse events (RR 0.78, 95% CI 0.61–1.00, <italic>P</italic> = 0.05). However, we did not observe any significant difference in terms of adverse events or mortality. Further, the subgroup analysis demonstrated that the anti-complement protein C5 monoclonal antibody (eculizumab) might have a lower relapse risk (RR 0.07, 95% CI 0.02–0.23, <italic>P</italic> &lt; 0.0001) in the AQP4 seropositive patients, and anti-interleukin-6 receptor monoclonal antibodies (satralizumab and tocilizumab) showed decreased EDSS score (mean −0.17, 95% CI −0.31−0.02, <italic>P</italic> = 0.02) more effectively than other monoclonal antibodies.</p><p><bold>Conclusions:</bold> Monoclonal antibodies were effective and safe in NMOSD. Different targets of monoclonal antibodies might have their own advantages.</p>