Monoclonal Antibody-Based Therapies for AQP4-Positive NMOSD

A Registry Study on Monoclonal Antibody-Based Therapies for Aquaporin-4 Antibody-Positive Neuromyelitis Optica Spectrum Disorders

The primary objective of this registry study is to evaluate the therapeutic efficacy and safety profiles of distinct monoclonal antibody-based therapies for aquaporin-4 immunoglobulin G-seropositive neuromyelitis optica spectrum disorders within the Chinese population under real-world clinical conditions. Secondary objectives include quantitative assessment of longitudinal neuroimaging biomarker variations and immunological profile alterations in longitudinal biological specimens pre- and post-therapeutic intervention.

Study Overview

• Status: Recruiting
• Conditions: NMO Spectrum Disorder
• Intervention / Treatment: Drug: Mab Therapy

• Study Type: Observational
• Enrollment (Estimated): 200

Contacts and Locations

Study Locations

• China
  • Hubei
    • Wuhan, Hubei, China, 430030
      • Recruiting
      • Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology
      • Contact: Ke Shang, PhD; Phone Number: 8602783663477; Email: kay_sang@hust.edu.cn

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

Confirmed diagnosis of aquaporin-4 immunoglobulin G (AQP4-IgG)-seropositive neuromyelitis optica spectrum disorders (NMOSD) per the 2015 International Consensus Diagnostic Criteria, with serological or cerebrospinal fluid verification of AQP4-IgG positivity for inclusion in the AQP4-NMOSD cohort.

Description

Inclusion Criteria:

• Subjects must demonstrate capacity to comprehend the study's objectives and associated risks, provide written informed consent, and authorize utilization of confidential health information in compliance with national and regional data protection regulations.
• Enrollment is permitted regardless of biological sex, with age ≥18 and ≤65 years (inclusive) at the time of informed consent provision.
• All females of childbearing potential and biologically male participants must employ contraceptive measures meeting clinical trial standards throughout the study duration and for at least 30 days following the final administration of investigational therapy. Additionally, participants must abstain from gamete donation during the study period and for ≥30 days post-treatment cessation.
• Confirmed diagnosis of aquaporin-4 immunoglobulin G (AQP4-IgG)-seropositive neuromyelitis optica spectrum disorders (NMOSD) per the 2015 International Consensus Diagnostic Criteria, with serological or cerebrospinal fluid verification of AQP4-IgG positivity for inclusion in the AQP4-NMOSD cohort. Participants must have provided documented consent for therapeutic intervention with one monoclonal antibody-based biologics.
• Neurological examination demonstrating clinical stability within 30 days preceding baseline (Visit 1).

Exclusion Criteria:

• Medical History and Current Health Status

  1. Clinically significant medical history of cardiac, endocrine, hematologic, hepatic, immune, infectious, metabolic, renal, pulmonary, neurological, dermatologic, psychiatric, or other major systemic conditions that, in the investigator's judgment, would preclude safe trial participation.
  2. Prior cerebrovascular events resulting in a baseline modified Rankin Scale (mRS) score >3.
  3. Hypersensitivity to the investigational therapeutic agent(s) or their excipients.

• Infection Risk

  1. Documented history or positive screening test for human immunodeficiency virus (HIV).
  2. Active hepatitis C virus (HCV) infection, defined as detectable HCV RNA with concomitant anti-HCV antibody positivity. Subjects with anti-HCV antibody positivity and undetectable HCV RNA remain eligible.
  3. Active hepatitis B virus (HBV) infection, defined as hepatitis B surface antigen (HBsAg) positivity and/or total hepatitis B core antibody (anti-HBc) positivity. Subjects with prior natural infection (HBsAg-negative, anti-HBc-positive, and anti-HBs-positive) or vaccination-induced immunity (HBsAg-negative, anti-HBc-negative, and anti-HBs-positive) are eligible.
  4. Chronic, recurrent, or severe infections (e.g., pneumonitis, sepsis) within 90 days prior to baseline (Visit 1).
  5. History of active tuberculosis (TB) or latent TB infection, defined by positive interferon-gamma release assay (IGRA) results or two consecutive tuberculin skin tests.
  6. Active bacterial, fungal, or viral infections (including upper respiratory tract infections) within 28 days prior to baseline. Subjects with localized fungal infections (e.g., candidiasis, dermatophytosis) may undergo re-screening post-treatment.
  7. Contraindications to rescue therapies, including rituximab, intravenous immunoglobulin (IVIG), high-dose corticosteroids, or cyclophosphamide.
  8. Prior exposure to total lymphoid irradiation, cladribine, T-cell or T-cell receptor vaccination, total body irradiation, or hematopoietic stem cell transplantation at any time.

• Additional Exclusion Criteria

  1. Clinically significant suicidal ideation or behavior within the past 12 months, as assessed by the Columbia-Suicide Severity Rating Scale (C-SSRS).
  2. Unwillingness or inability to comply with protocol-mandated procedures.
  3. Severe auditory/visual impairment, language barriers, claustrophobia, or other conditions precluding neuropsychological assessments or MRI completion.
  4. Any other condition deemed by the investigator or sponsor to compromise subject eligibility or study integrity.

Study Plan

How is the study designed?

Number of groups / cohorts

6

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Inebilizumab treatment; AQP4-IgG positive NMOSD Patient who received Inebilizumab	Drug: Mab Therapy; Whether receive mab therapy or not.
Satralizumab treatment; AQP4-IgG positive NMOSD Patient who received Satralizumab	Drug: Mab Therapy; Whether receive mab therapy or not.
Eculizumab treatment; AQP4-IgG positive NMOSD Patient who received Eculizumab	Drug: Mab Therapy; Whether receive mab therapy or not.
Ofatumumab treatment; AQP4-IgG positive NMOSD Patient who received Ofatumumab	Drug: Mab Therapy; Whether receive mab therapy or not.
Rituximab treatment; AQP4-IgG positive NMOSD Patient who received Rituximab	Drug: Mab Therapy; Whether receive mab therapy or not.
Conventional immunosuppressive agents treatment; AQP4-IgG positive NMOSD Patient who received Conventional immunosuppressive agents

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Time to first relapse	Up to 96 weeks
Median time to relapse	Up to 96 weeks
Annualized relapse rate	Up to 96 weeks
EDSS score	Up to 96 weeks

Secondary Outcome Measures

Outcome Measure	Time Frame
Incidence of radiologically identified new gadolinium-enhancing lesions and/or new or enlarging T2-weighted lesions	Up to 96 weeks
AQP4-IgG titer in serum and cerebral spinal fluid	Up to 96 weeks

Collaborators and Investigators

• Sponsor: Tongji Hospital

Study record dates

Study Major Dates

• Study Start (Actual): July 1, 2025
• Primary Completion (Estimated): June 30, 2027
• Study Completion (Estimated): December 31, 2027

Study Registration Dates

• First Submitted: March 13, 2025
• First Submitted That Met QC Criteria: March 13, 2025
• First Posted (Actual): March 20, 2025

Study Record Updates

• Last Update Posted (Estimated): September 8, 2025
• Last Update Submitted That Met QC Criteria: September 5, 2025
• Last Verified: September 1, 2025

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Nervous System Diseases; Autoimmune Diseases; Immune System Diseases; Eye Diseases; Demyelinating Autoimmune Diseases, CNS; Autoimmune Diseases of the Nervous System; Demyelinating Diseases; Myelitis, Transverse; Optic Neuritis; Optic Nerve Diseases; Cranial Nerve Diseases; Neuromyelitis Optica
• Other Study ID Numbers: MabInNMOSD

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No