Abstract | BACKGROUND: METHODS: In a phase 3, randomized, double-blind, placebo-controlled trial, we randomly assigned, in a 1:1 ratio, patients with NMOSD who were seropositive or seronegative for AQP4-IgG to receive either satralizumab, at a dose of 120 mg, or placebo, administered subcutaneously at weeks 0, 2, and 4 and every 4 weeks thereafter, added to stable immunosuppressant treatment. The primary end point was the first protocol-defined relapse in a time-to-event analysis. Key secondary end points were the change from baseline to week 24 in the visual-analogue scale (VAS) pain score (range, 0 to 100, with higher scores indicating more pain) and the Functional Assessment of Chronic Illness Therapy- Fatigue (FACIT-F) score (range, 0 to 52, with lower scores indicating more fatigue). Safety was also assessed. RESULTS: A total of 83 patients were enrolled, with 41 assigned to the satralizumab group and 42 to the placebo group. The median treatment duration with satralizumab in the double-blind period was 107.4 weeks. Relapse occurred in 8 patients (20%) receiving satralizumab and in 18 (43%) receiving placebo (hazard ratio, 0.38; 95% confidence interval [CI], 0.16 to 0.88). Multiple imputation for censored data resulted in hazard ratios ranging from 0.34 to 0.44 (with corresponding P values of 0.01 to 0.04). Among 55 AQP4-IgG-seropositive patients, relapse occurred in 11% of those in the satralizumab group and in 43% of those in the placebo group (hazard ratio, 0.21; 95% CI, 0.06 to 0.75); among 28 AQP4-IgG-seronegative patients, relapse occurred in 36% and 43%, respectively (hazard ratio, 0.66; 95% CI, 0.20 to 2.24). The between-group difference in the change in the mean VAS pain score was 4.08 (95% CI, -8.44 to 16.61); the between-group difference in the change in the mean FACIT-F score was -3.10 (95% CI, -8.38 to 2.18). The rates of serious adverse events and infections did not differ between groups. CONCLUSIONS:
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Authors | Takashi Yamamura, Ingo Kleiter, Kazuo Fujihara, Jacqueline Palace, Benjamin Greenberg, Beata Zakrzewska-Pniewska, Francesco Patti, Ching-Piao Tsai, Albert Saiz, Hayato Yamazaki, Yuichi Kawata, Padraig Wright, Jerome De Seze |
Journal | The New England journal of medicine
(N Engl J Med)
Vol. 381
Issue 22
Pg. 2114-2124
(11 28 2019)
ISSN: 1533-4406 [Electronic] United States |
PMID | 31774956
(Publication Type: Clinical Trial, Phase III, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
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Copyright | Copyright © 2019 Massachusetts Medical Society. |
Chemical References |
- Antibodies, Monoclonal, Humanized
- Aquaporin 4
- Autoantibodies
- Immunoglobulin G
- Immunosuppressive Agents
- Receptors, Interleukin-6
- satralizumab
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Topics |
- Adolescent
- Adult
- Aged
- Antibodies, Monoclonal, Humanized
(adverse effects, therapeutic use)
- Aquaporin 4
(immunology)
- Autoantibodies
(blood)
- Double-Blind Method
- Drug Therapy, Combination
- Female
- Humans
- Immunoglobulin G
(blood)
- Immunosuppressive Agents
(therapeutic use)
- Male
- Middle Aged
- Neuromyelitis Optica
(drug therapy, immunology)
- Receptors, Interleukin-6
(antagonists & inhibitors, immunology)
- Recurrence
- Young Adult
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