Matching-adjusted Indirect Comparison of Current Treatments for NMOSD and Evaluation of Long-term Effectiveness
Friedemann Paul1, Orhan Aktas2, Mikkel Pedersen3, Francesc Sorio-Vilela4, Kristina Patterson4, Nishi Rampal4, Daniel Cimbora4, Bruce Cree5
1Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine, Charité – Universitätsmedizin Berlin, Berlin, Germany, 2Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany, 3EY Economics, Frederikssberg, Denmark, 4Amgen Research, Amgen Inc, Thousand Oaks, CA, USA, 5Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA
Objective:
To perform a matching adjusted indirect comparison (MAIC) utilizing investigator adjudicated attacks (IAA) as a sensitivity analysis to further support the relative effectiveness of inebilizumab relative to other current Neuromyelitis Optica Spectrum Disorder (NMOSD) therapies.
Background:

 NMOSD is a chronic, autoimmune disease characterized by recurrent attacks on the central nervous system causing permanent neurological damage and cumulative disability impacting health-related quality of life. Previously, a MAIC using committee adjudicated attacks provided a robust and rigorous trial comparison of two current NMOSD therapies, inebilizumab and satralizumab, supporting an informed evidence-based therapy decision.

Design/Methods:

An anchored MAIC compared the relative efficacy of inebilizumab to eculizumab and satralizumab based on published data from randomized control trials in adults with aquaporin-4 seropostive (AQP4+) NMOSD. Estimates were expressed as the relative risks of experiencing an NMOSD attack based on time to first IAA with the N-MOmentum inebilizumab AQP4+ population compared to each treatment. Subsequently, based on the calculated relative risks, a model was built to estimate long term effectiveness presented as life years and quality-adjusted life years. The model simulated NMOSD-related mortality based on disease progression.  

Results:

The relative risk (RR [CI]) of experiencing an NMOSD attack with inebilizumab compared to eculizumab and satralizumab were 1.51 [0.70, 3.25], and 0.49 [0.19, 1.28] respectively. The calculated life years demonstrated an advantage for inebilizumab (21.90) compared with eculizumab (16.02) and satralizumab (20.79). Similarly, the quality adjusted life years shown and advantage for inebilizumab (12.55) compared with eculizumab (8.23) and satralizumab (11.34).

Conclusions:

Utilizing IAA for analysis of relative risk for NMOSD attack showed stronger results for treatment with inebilizumab than previously reported. Additionally, treatment with inebilizumab yields better results for expected life years and quality adjusted life years compared to either satralizumab or eculizumab. Relative efficacy and discontinuation were the key drivers of the results.

10.1212/WNL.0000000000204722