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N-MOmentum was a pivotal randomized phase 2/3 trial evaluating inebilizumab, a CD19-directed B-cell-depleting monoclonal antibody, in neuromyelitis optica spectrum disorder. Adults with NMOSD were randomised to inebilizumab or placebo and followed for protocol-defined attacks. The active-treatment group experienced fewer attacks, providing evidence that B-cell depletion can meaningfully alter the disease course. Subsequent analyses showed a lower risk of confirmed disability progression and more favourable modified Rankin outcomes with inebilizumab. The results are clinically important because NMOSD disability is largely attack-driven; preventing relapses can therefore be as important as treating residual symptoms after an attack. For HCPs, the study underscores the need for early diagnosis and long-term relapse prevention, especially in AQP4-positive disease. Treatment selection should account for prior immunotherapy, infection risk, vaccination and the logistics of ongoing therapy. The trial also strengthens the broader principle of mechanism-based treatment in neuroimmunology: identifying the immune pathway driving disease can directly inform treatment choice.
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N-MOmentum was a pivotal randomized phase 2/3 trial evaluating inebilizumab, a CD19-directed B-cell-depleting monoclonal antibody, in neuromyelitis optica spectrum disorder. Adults with NMOSD were randomised to inebilizumab or placebo and followed for protocol-defined attacks. The active-treatment group experienced fewer attacks, providing evidence that B-cell depletion can meaningfully alter the disease course. Subsequent analyses showed a lower risk of confirmed disability progression and more favourable modified Rankin outcomes with inebilizumab. The results are clinically important because NMOSD disability is largely attack-driven; preventing relapses can therefore be as important as treating residual symptoms after an attack. For HCPs, the study underscores the need for early diagnosis and long-term relapse prevention, especially in AQP4-positive disease. Treatment selection should account for prior immunotherapy, infection risk, vaccination and the logistics of ongoing therapy. The trial also strengthens the broader principle of mechanism-based treatment in neuroimmunology: identifying the immune pathway driving disease can directly inform treatment choice.
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