Enspryng outperforms standard immunosuppressants in NMOSD study
Therapy reduced relapse rates for up to 3 years, with comparable safety profile
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Enspryng (satralizumab) is superior to conventional immunosuppressive therapies in reducing the risk of relapses in people with neuromyelitis optica spectrum disorder (NMOSD) for up to three years, and with a comparable safety profile, according to a real-world study.
Similar results were obtained when analyzing data only from NMOSD patients with self-reactive antibodies targeting the aquaporin-4 (AQP4) protein, the most common type of NMOSD-driving antibodies.
This real-world study “supports the findings of previous clinical trials, demonstrating that [Enspryng] significantly reduces relapse rates in NMOSD patients compared to conventional immunosuppressants, without increasing the incidence of adverse events,” researchers wrote.
The study, “Real-World Investigation of Satralizumab in Patients With Neuromyelitis Optica Spectrum Disease,” was published in Annals of Clinical and Translational Neurology.
Enspryng blocks key pro-inflammatory molecule
NMOSD is a rare autoimmune disease marked by episodes of damaging inflammation that primarily affect the spinal cord and the optic nerve, the nerve that relays signals between the eye and the brain.
Enspryng is an injection therapy approved for adults with NMOSD who are positive for anti-AQP4 antibodies. It works by blocking the receptor protein of interleukin-6 (IL-6), a pro-inflammatory molecule that is involved in the autoimmune attacks that drive NMOSD.
To learn more about the treatment’s long-term safety and efficacy in a real-world setting, researchers at Taipei Medical University in Taiwan accessed data from the international TriNetX federated health research platform, which collects electronic healthcare records from more than 150 healthcare organizations, in April 2025.
A total of 220 NMOSD patients were treated with Enspryng, and 1,744 received conventional immunosuppressants. After matching patients with similar characteristics, 218 participants were included in each group. Most were women (more than 85% in both groups), and aparticipants had a median age of about 49 years.
Approximately one-third of the patients in both groups had previously experienced optic neuritis, or inflammation of the optic nerve. At the same time, about one-quarter had high blood pressure, and about one in 10 had diabetes.
The most common treatments were oral prednisone, used in 54.1% of those in the Enspryng group and 57.8% of those in the conventional immunosuppressants group, followed by rituximab (33.9% and 34.9%, respectively).
Follow-up data were available for 218 matched patient pairs at one year, 118 pairs at two years, and 54 pairs at three years.
Enspryng had lower risk of relapse at all follow-up times up to 3 years
Results showed that people treated with Enspryng had a significantly lower risk of relapse than those on conventional immunosuppressants at all analyzed follow-up times up to three years. For instance, the risk was reduced by 62% after one month, 37% after one year, 40% after two years, and 48% after three years.
Across all follow-up periods, the number needed to treat, an objective measure of treatment efficacy, was consistently between four and nine. This means that four to nine patients needed to be treated with Enspryng for one additional person to benefit by avoiding a relapse, indicating the treatment was effective.
When analyzing only patients who tested positive for anti-AQP4 antibodies (78 in each group), the team found that the relapse risk was about 50% lower over a year for those treated with Enspryng relative to those on traditional immunosuppressive treatments.
Similar results were seen for up to three years when comparing patients treated with Enspryng alone (monotherapy) with those on conventional immunosuppressants.
[Enspryng] demonstrated superior efficacy in reducing NMOSD relapse rates compared to conventional immunosuppressants while maintaining a comparable safety profile.
Additionally, Enspryng monotherapy reduced the risk of relapse by 62% to 70% over three years compared to rituximab monotherapy, a non-conventional immunosuppressive medication commonly used off-label in NMOSD.
“Across all follow-up intervals, there were no statistically significant differences between the [Enspryng] and conventional immunosuppressant groups” in terms of rates of adverse events, the team wrote.
The most reported adverse events in both groups were urinary tract infections, affecting up to 35% of the patients. Up to 24% of participants experienced anemia, characterized by low levels of red blood cells.
Fewer than 10 patients experienced respiratory infections, sepsis, low platelet counts (blood fragments essential for blood clotting), or died during follow-up. Sepsis refers to an extreme immune response to infection that may cause organ damage.
Overall, the study shows that Enspryng “demonstrated superior efficacy in reducing NMOSD relapse rates compared to conventional immunosuppressants while maintaining a comparable safety profile,” the researchers wrote.
