WCN 2021 | PREVENT study: eculizumab in AQP4-IgG-positive NMOSD

Kazuo Fujihara, MD, PhD, Fukushima Medical University School of Medicine, Fukushima, Japan, shares the results from the PREVENT study (NCT01892345) and its open-label extension (NCT02003144). This Phase III study evaluating eculizumab in patients with aquaporin-4 immunoglobulin G antibodies (AQP4-IgG)-positive neuromyelitis optica spectrum disorder (NMOSD) reported a reduction of 94% in the risk of relapse with eculizumab. Moreover, 37% of patients were able to discontinue or reduce the dose of immunosuppressive therapy (IST), which led to a reduction in IST-related adverse events. Additionally, eculizumab monotherapy appeared to be very effective. Dr Fujihara underlines the importance of vaccinating patients against meningococcal meningitis as eculizumab inhibits the complement, which is critical in protection against meningococcal infections. In addition, common missense heterozygous variations near eculizumab’s binding site in the C5 gene found in Japanese and East Asian populations reduce the efficacy of this drug. It is therefore important to test for such mutations prior to treatment. This interview took place during the XXV World Congress of Neurology.