Safety and efficacy of ravulizumab in patients with NMOSD previously treated with rituximab: a post hoc analysis of the CHAMPION-NMOSD trial

OBJECTIVE: This post hoc analysis of the CHAMPION���NMOSD trial evaluated the safety and efficacy of ravulizumab in patients with aquaporin‐4 antibody‐positive (AQP4‐Ab+) neuromyelitis optica spectrum disorder (NMOSD) previously exposed or naïve to rituximab (RTX). METHODS: Patients received weight‐based intravenous ravulizumab with a loading dose followed by maintenance dosing every 8 weeks. Patients were stratified by prior RTX exposure: no RTX exposure (RTX‐naïve) vs RTX exposure > 3 months before initiating ravulizumab (RTX‐exposed). Key outcomes included treatment‐emergent adverse events (TEAEs), serious TEAEs (TESAEs), relapse rates, and vaccination timing from the last RTX dose. RESULTS: Of the 58 patients enrolled, 89.7% were female, with a mean age of 47.4 years, and 21/58 (36.2%) were RTX‐exposed. Relapses occurred in 12/21 (57.1%) RTX‐exposed patients between their first RTX dose and study entry. The safety profile of ravulizumab was generally similar between RTX‐exposed and RTX‐naïve groups. Common TEAEs included COVID‐19, headache, urinary tract infection, and upper respiratory tract infection. UTIs were more frequent in RTX‐exposed individuals. One patient in each group experienced a meningococcal infection. No adjudicated on‐trial relapses were reported while on ravulizumab. CONCLUSIONS: Following initiation of ravulizumab, RTX‐exposed and RTX‐naïve patients with AQP4‐Ab+ NMOSD achieved sustained disease control and demonstrated a manageable safety profile. CLINICAL TRIAL INFORMATION: The CHAMPION‐NMOSD Trial; ClinicalTrials.gov identifier: NCT04201262 (registered October 06, 2020).