Neuro-ophthalmology CME ACCREDITED Watch Time: 60 mins

touchSATELLITE SYMPOSIUM Seeing a difference in Neuromyelitis Optica
Spectrum Disorder: integrating novel strategies into care

Join our panel of experts as they discuss the rationale for and latest data on novel therapies for neuromyelitis optica sepctrum disorder and how to integrate them into patient care.

Prof. Jackie Palace

Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, UK

CHAIR

Panelists:
Prof. Kazuo Fujihara, Prof. Sean Pittock
  • Video Chapters
Watch Time: 03:11

Prof. Jackie Palace introduces Prof. Kazuo Fujihara and Prof. Sean Pittock and walks through the agenda and educational objectives for this activity.

 
Watch Time: 12:50

Prof. Kazuo Fujihara starts by differentiating NMOSD from multiple sclerosis, and goes on to discuss the role of biomarkers and how early and accurate diagnosis can reduce the significant burden of NMOSD on patients.

 
Watch Time: 11:51

Prof. Sean Pittock gives an overview of novel targets in NMOSD and looks at the efficacy and safety data for three new agents and their potential to prevent NMOSD attacks in a more targeted way.

 
Watch Time: 16:58

The expert panel discusses a patient case presented by Prof. Jackie Palace to highlight optimal treatment-decision making and when to consider novel therapies.

 
Watch Time: 13:33

A live Q&A discussion recorded at MSVirtual 2020.

 
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Overview & Learning Objectives
Overview

In this activity, Prof. Jackie Palace chairs a Satellite Symposium at MSVirtual 2020 (11–13 September 2020) to address key issues around the integration of novel therapies for neuromyelitis optica spectrum disorder (NMOSD) into care. This includes discussion with Prof. Kazuo Fujihara and Prof. Sean Pittock on the importance of early and accurate diagnosis, the clinical implications of the latest data on novel therapies and their potential use in patients with NMOSD.

This activity has been jointly provided by Oakstone Publishing and touchIME. Oakstone Publishing is accredited by the ACCME to provide continuing medical education to physicians.

Target audience

This activity has been designed to meet the educational needs of neurologists, including MS specialists, together with ophthalmologists involved in the management of NMOSD.

Disclosures

Oakstone Publishing has assessed conflict of interest with its faculty, authors, editors, and any individuals who were in a position to control the content of this CME activity. Any identified relevant conflicts of interest were resolved for fair balance and scientific objectivity of studies utilized in this activity. Oakstone Publishing’s planners, content reviewers, and editorial staff disclose no relevant commercial interests.

Faculty

Prof. Jackie Palace discloses: Grants/research support from: Merck Serono, Myware and Sparks (Great Ormond Street Hospital’s Charity).  Consultant/advisory boards for: Amplo, Alexion Pharmaceuticals, Argenx, Blueprint Medicines, Merck, Mitsubishi, Roche, Viela Bio, Vitaccess and UCB.

Prof. Kazuo Fujihara discloses: Consultant/advisory boards for: Alexion Pharmaceuticals, Asahi Kasei, Biogen, Chugai Pharmaceutical Co., Novartis, Mitsubishi Tanable, Takeda, Teijin Limited and Viela Bio.

Prof. Sean Pittock discloses: Grants/personal fees/other from: Alexion Pharmaceuticals, Astellas, Autoimmune Encephalitis Alliance, Grifols, MedImmune and UCB.  Patents issued: Patent # 8,889,102 (Application # 12-678350, Neuromyelitis Optica autoantibodies as a marker for neoplasia); Patent# 9,891,219B2 (Application # 12-573942, Methods for treating Neuromyelitis Optica [NMO] by administration of eculizumab to an individual that is aquaporin-4 (AQP4)-IgG autoantibody positive).

Content Reviewer

Walter Murray Yarbrough, MD has no financial interests/relationships or affiliations in relation to this activity.

Touch Medical Director

Kathy Day has no financial interests/relationships or affiliations in relation to this activity.

Requirements for Successful Completion

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of Oakstone Publishing and touchIME. Oakstone Publishing is accredited by the ACCME to provide continuing medical education for physicians.

The European Union of Medical Specialists (UEMS) – European Accreditation Council for Continuing Medical Education (EACCME) has an agreement of mutual recognition of continuing medical education (CME) credit with the American Medical Association (AMA).  European physicians interested in converting AMA PRA Category 1 Credit™ into European CME credit (ECMEC) should contact the UEMS (www.uems.eu) 

Oakstone Publishing designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credit™️. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

In order to receive credit for this activity, participants must review and complete the post-test and evaluation form. Statements of credit are awarded upon successful completion of the post-test and evaluation form.

Date of original release: 16 December 2020.  Date credits expire: 16 December 2021.

Learning Objectives

After watching this activity, participants should be better able to:

  • Outline strategies for early and accurate diagnosis of neuromyelitis optica spectrum disorder (NMOSD)
  • Describe how novel treatment options target the pathophysiology of NMOSD to prevent relapse
  • Assess recent phase III results for novel therapies and how these may impact treatment decisions in NMOSD
Faculty & Disclosures
Prof. Jackie Palace

Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, UK

Jackie Palace is a consultant neurologist in Oxford and Professor in the Nuffield Department of Clinical Neurosciences, Oxford University.  She leads the Oxford Multiple Sclerosis group, runs a national service for congenital myasthenic syndromes (CMS), and jointly runs a UK neuromyelitis optica (NMO) service. read more

Her research interests cover multiple sclerosis (MS), NMO, CMS and myasthenia gravis, and include clinical treatment trials, immunological studies, pathology, biomarkers, genetics and imaging studies. She has been a UK lead for the National Risk Sharing Scheme, which assessed the long-term effectiveness for disease- modifying agents in MS. She is also a board member for the European Charcot Foundation, on the steering committee for the Magnetic Resonance Imaging in MS and is the Oxford lead for the European Reference Network for Rare Neuromuscular Diseases.

Grants/research support from: Merck Serono, Myware and Sparks (Great Ormond Street Hospital’s Charity).  Consultant/advisory boards for: Amplo, Alexion Pharmaceuticals, Argenx, Blueprint Medicines, Merck, Mitsubishi, Roche, Viela Bio, Vitaccess and UCB.

Prof. Kazuo Fujihara

Department of Multiple Sclerosis Therapeutics, Fukushima Medical University School of Medicine, Fukushima, Japan

Kazuo Fujihara is Professor in the Department of Multiple Sclerosis Therapeutics at the Fukushima Medical University School of Medicine, and Director of the Multiple Sclerosis and Neuromyelitis Optica Center, Southern Tohoku Research Institute for Neuroscience, in Koriyama, Japan.

He is a neurologist and has mainly worked in the field of multiple sclerosis (MS), neuromyelitis optica (NMO) and related neuroimmunological disorders. He is a member of the International Panel on Diagnosis of MS (and he contributed to the 2010 and 2017 revisions to the McDonald Criteria) and the International Panel on NMO Diagnosis (contributing to the 2015 International Consensus Diagnostic Criteria of NMO Spectrum Disorder). read more

Since 2013, he has served on the Executive Committee and is a member of the International Medical and Scientific Board of the Multiple Sclerosis International Federation (MSIF), and has served on the Board of the European Charcot Foundation. He is an inaugural member and President of the Pan-Asian Committee for Treatment and Research in Multiple Sclerosis, President of the Japanese Society for Neuroimmunology, an honorary member of the Association of Sri Lankan Neurologists, honorary corresponding member of the Indian Academy of Neurology and honorary fellow of the Hong Kong Society of Multiple Sclerosis. Prof. Fujihara is an editorial board member of Neurology: Neuroimmunology and Neuroinflammation and Multiple Sclerosis and Related Disorders, and Associate Editor of multiple sclerosis and neuroimmunology for Frontiers in Neurology.

Consultant/advisory boards for: Alexion Pharmaceuticals, Asahi Kasei, Biogen, Chugai Pharmaceutical Co., Novartis, Mitsubishi Tanable, Takeda, Teijin Limited and Viela Bio.

Prof. Sean Pittock

Center for Multiple Sclerosis and Autoimmune Neurology, and the Neuroimmunology Research Laboratory, Mayo Clinic, Rochester, MN, USA

Sean Pittock is Professor of Neurology and Director of the Neuroimmunology Laboratory and the Center for Multiple Sclerosis (MS) and Autoimmune Neurology at the Mayo Clinic in Rochester, MN, USA.

His expertise is in the laboratory- and clinic-based diagnosis and management of immune-mediated neurological disorders. He is considered a leader in the field of glial autoimmunity as it pertains to inflammatory central nervous system (CNS) demyelinating diseases, including MS. read more

He directs the Mayo Clinic Neuroimmunology Laboratory, a leading centre that tests patients for comprehensive neural antibody profiles related to inflammatory CNS disorders. As Director of the Center for Multiple Sclerosis and Autoimmune Neurology at the Mayo Clinic, he has assisted in building the largest biorepository of blood and cerebrospinal fluid samples from patients with MS and inflammatory CNS disorders in the world. The laboratory also provides testing for biomarkers of type 1 diabetes, allowing the collection and storage of more than 1,000 serum samples.

He currently serves as the chair of the Autoimmune Neurology Section at the American Academy of Neurology, has published more than 300 peer-reviewed papers in the field of MS and autoimmune neurology, and recently co-edited the first textbook of autoimmune neurology.

Grants/personal fees/other from: Alexion Pharmaceuticals, Astellas, Autoimmune Encephalitis Alliance, Grifols, MedImmune and UCB.  Patents issued: Patent # 8,889,102 (Application # 12-678350, Neuromyelitis Optica autoantibodies as a marker for neoplasia); Patent# 9,891,219B2 (Application # 12-573942, Methods for treating Neuromyelitis Optica [NMO] by administration of eculizumab to an individual that is aquaporin-4 (AQP4)-IgG autoantibody positive).

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Question 1/5
What is the function of aquaporin-4 (AQP4) on astrocyte endfeet?
Correct

AQP4 is a water channel found on astrocyte endfeet that mediates water homeostasis between the blood supply and CSF, and may also assist with the movement of waste proteins.

AQP4, aquaporin-4; CSF, cerebrospinal fluid

Reference:

Mader S, Brimberg L. Cells. 2019;8:90.

Question 2/5
Which of the following novel neuromyelitis optica spectrum disorder (NMOSD) therapies act on plasmablast receptors?
Correct

Satralizumab and inebilizumab target plasmablast IL-6 and CD-19 receptors, respectively, to reduce AQP4-IgG production, while eculizumab targets complement 5, to stop the complement cascade and formation of membrane attack complexes. Natalizumab is an MS therapy and does not act on plasmablasts.

AQP4-IgG, aquaporin-4 immunoglobulin; CD, cluster of differentiation; IL, interleukin; MS, multiple sclerosis

Reference:

Selmaj K and Selmaj I. Neurol Neurochir Pol. 2019;53:317–326.

Question 3/5
What is the target of the neuromyelitis optica spectrum disorder (NMOSD) antibody therapy eculizumab?
Correct

The target of eculizumab is the complement cascade protein complement 5. 

Reference:

Selmaj K and Selmaj I. Neurol Neurochir Pol. 2019;53:317–326.

Question 4/5
By approximately how much do novel antibody therapies for neuromyelitis optica spectrum disorder (NMOSD) reduce the risk of attacks compared with placebo?
Correct

In placebo-controlled phase III studies involving satralizumab, inebilizumab and eculizumab, the risk of NMOSD attacks was reduced by 75%, 77% and 94%, respectively.1–3

NMOSD, neuromyelitis optica spectrum disorder

References:

  1. Haskova Z, et al. Invest Ophthalmol Vis Sci. 2020;61:3173.
  2. Cree BAC, et al. Lancet. 2019;94:1352–63.
  3. Pittock SJ, et al. N Engl J Med. 2019;381:614–25.
Question 5/5
What should be the primary goal of immunotherapy for neuromyelitis optica spectrum disorder (NMOSD)?
Correct

The goal of preventive immunotherapy is the absence of attacks, as prolonged relapse-free remission should be associated with neurologic stability or improvement.

Reference:

Weinshenker BG, Wingerchuk DM. Mayo Clin Proc. 2017;92:663–679.

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