Neurology® Podcast Eculizumab Use in Neuromyelitis Optica Spectrum Disorders
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Oct 31, 2024 Dr. Marius Ringelstein, a neurologist from Heinrich Heine University specializing in Neuromyelitis Optica Spectrum Disorders (NMOSD), and Dr. Ilya Ayzenberg from Rory University discuss the use of Eculizumab in treating NMOSD. They emphasize the drug's effectiveness and safety, particularly concerning vaccination against meningococcal infections for patients. The conversation highlights vaccination protocols and the timing of treatments, as well as the promising alternative of Ravulizumab for less frequent dosing. Practical insights shape their review of patient-centered care.
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Mechanism Targets Astrocyte Injury
- Eculizumab blocks C5 cleavage preventing formation of C5a and C5b and thereby reduces astrocyte destruction in AQP4-IgG NMOSD.
- The drug targets core disease pathophysiology, explaining its high efficacy in preventing relapses.
Mandatory Meningococcal Protection
- Vaccinate against meningococcus and consider antibiotic prophylaxis because eculizumab raises meningococcal infection risk roughly 2,000-fold.
- Make meningococcal vaccination or antibiotic prophylaxis mandatory before or during complement inhibitor therapy.
High Effectiveness In Severely Disabled Patients
- Real-world eculizumab was highly effective at preventing NMOSD attacks, even in patients with higher baseline disability than trial cohorts.
- The cohort's median EDSS was 6.0 at treatment start, yet relapse reduction and MRI improvements were still observed.