Efficacy and safety of inebilizumab in Asian participants with neuromyelitis optica spectrum disorder: Subgroup analyses of the N-MOmentum study

BACKGROUND

Inebilizumab, an anti-CD19 B cell-depleting antibody, reduced the risk of a neuromyelitis optica spectrum disorder (NMOSD) attack, disability worsening, magnetic resonance imaging (MRI) lesion activity, and disease-related hospitalizations in participants with NMOSD in the N-MOmentum study (NCT02200770). However, the efficacy and safety outcomes of inebilizumab specific to an Asian population were not fully reported. Therefore, subgroup analyses of the N-MOmentum study were conducted post hoc to evaluate the efficacy and safety of inebilizumab in Asian participants with NMOSD.

METHODS

The N-MOmentum study was a multicenter, double-blind, randomized, placebo-controlled phase 2/3 trial with an open-label extension period (OLP). In the subgroup analyses, data from Asian participants from the N-MOmentum study were compared with those of non-Asian participants. Eligible participants were randomly allocated (3:1) to receive 300 mg intravenous (IV) inebilizumab or placebo on Days 1 and 15. Participants who had an NMOSD attack or completed the randomized controlled period (RCP) could enter the OLP, where they received inebilizumab for ≥2 years. All participants who entered the OLP received inebilizumab 300 mg IV every 6 months.

RESULTS

Overall, 230 participants received treatment (174 received inebilizumab and 56 received placebo), of whom 47 were Asian (39 received inebilizumab and 8 received placebo). Baseline characteristics were similar between the Asian and non-Asian subgroups, except for disease duration, annualized relapse rate prior to randomization in this study, and previous maintenance therapy. In the Asian subgroup, the risk of NMOSD attacks was reduced with inebilizumab versus placebo (hazard ratio, 0.202) and the attack-free rate at 28 weeks was 82.1% with inebilizumab versus 37.5% with placebo, in the 6-month RCP. NMOSD attack rates were comparable between the Asian and non-Asian subgroups. In the Asian subgroup, the rates of Expanded Disability Status Scale worsening from baseline, active MRI lesions, and disease-related hospitalizations tended to be lower in the inebilizumab group than in the placebo group; similar results were shown in the non-Asian subgroup. For long-term efficacy and safety (RCP and OLP), the annualized adjudicated NMOSD attack rate in Asian participants treated with inebilizumab was reduced (0.096) compared with that at baseline (1.04), with a mean follow-up period of inebilizumab treatment of 3.38 years, which was consistent with the results in the non-Asian subgroup. The risk of NMOSD attack decreased with prolonged duration of treatment in both the inebilizumab/inebilizumab and placebo/inebilizumab groups in the Asian and non-Asian subgroups. The incidence of treatment-emergent adverse events (TEAEs) was similar between the Asian and non-Asian subgroups. In the Asian and non-Asian subgroups, 15.2% and 35.2% of participants, respectively, had at least one serious TEAE and/or Grade ≥3 TEAE during long-term therapy. No deaths occurred in the Asian subgroup whereas three deaths occurred in the non-Asian subgroup.

CONCLUSION

Inebilizumab reduced the risk of an NMOSD attack, progression of disability, MRI lesion activity, and disease-related hospitalizations in Asian participants with NMOSD. The efficacy of inebilizumab in reducing NMOSD attacks continued without any unexpected safety signals or concerns during long-term use in Asian participants.

Effect of temporary materials on bond strength of resin-modified glass-ionomer luting cements to teeth

PURPOSE

To evaluate the effect of temporary materials on the bond strength of resin-modified glass-ionomer luting cements to teeth.

MATERIALS AND METHODS

240 freshly extracted bovine central incisors were ground to expose enamel and dentin surface. Fuji Lute and Vitremer Luting Cement were bonded to enamel and dentin surfaces after pretreatment for 1 week with (1) a eugenol-containing cement (Propac), (2) a eugenol-free cement (Freegenol Temporary Pack), (3) a polycarboxylate cement (HY-Bond Temporary Cement Hard), (4) a chemically cured temporary restorative resin (Plast Seal), and (5) a light-cured temporary restorative resin (Fermit). The flattened enamel and dentin surfaces were used as controls. After bonded specimens were stored in water at 37 degrees C for 24 hrs, the tensile bond strength was measured at a crosshead speed of 0.5 mm/min. The data were statistically analyzed by one-way ANOVA and Dunnett's Post-hoc Procedure (P < 0.05).

RESULTS

Plast Seal had no adverse effect on the tensile bond strength of Fuji Lute on both enamel and dentin surfaces, while the other temporary materials revealed significant decrease in bond strength. In Vitremer Luting Cement, Propac, and Fermit, as well as Plast Seal demonstrated tensile bond strengths similar to the controls.

Effect of dentin treatment with citric acid/ferric chloride solutions on glass ionomer bond strength

PURPOSE

To investigate the effect of dentin treatment with mixed solutions of citric acid and ferric chloride on the tensile bond strength of resin-modified glass ionomers.

MATERIALS AND METHODS

120 freshly extracted bovine incisors were ground to expose dentin surface. Vitremer and Fuji II LC were bonded to dentin surfaces that were (1) rinsed with distilled water and dried with oil-free compressed air, (2) treated with Super Bond Dentin Activator for 30 seconds, (3) treated with Bondwell LC Conditioner for 20 seconds, (4) treated with Scotchbond Multi-purpose Etchant for 15 seconds, (5) treated with Dentin Conditioner for 20 seconds, or (6) treated with K-etchant for 40 seconds following manufacturers' recommendations. Specimens were stored in water at 37 degrees C for 24 hours. The tensile bond strength was measured at a crosshead speed of 0.5 mm/minute. The data were statistically analyzed by a one-way ANOVA and Dunnett's Post-hoc Procedure (P < 0.05).

RESULTS

Super Bond Dentin Activator and Bondwell LC Conditioner increased the tensile bond strength of Vitremer and Fuji II LC. Scotchbond Multi-purpose Etchant, Dentin Conditioner, and K-etchant did not improve the tensile bond strength of Vitremer and Fuji II LC.

Effect of resinous temporary material on tensile bond strength of resin luting cement to tooth substrate

We investigated the effect of resinous temporary material on the tensile bond strength of resin luting cement to enamel and to dentin. Four hundred bovine incisor teeth were randomly divided into groups. Four resinous temporary materials and four resin luting cements were used. On enamel, none of the resinous temporary materials decreased the tensile bond strength of the cements. On dentin, all the resinous temporary materials decreased the tensile bond strength of the cements except one containing 4-META/MMA-TBB.

Characterization of enamel and dentin surfaces after removal of temporary cement--effect of temporary cement on tensile bond strength of resin luting cement

This study was performed to investigate the effect of temporary sealing with cement on the tensile bond strength of resin luting cement to tooth substrate. Five temporary cements and five resin luting cements were used. Six hundred bovine incisor teeth were randomly divided between each group. Effect of temporary sealing on the tensile bond strength of resin luting cement varied in accordance with the temporary cement used. Temporary sealing with both the eugenol-containing and the eugenol-free temporary cements decreased the tensile bond strength of resin luting cement. The tensile bond strength with one of the resin luting cements was most stable on both enamel and dentin pretreated with all temporary cements tested.

Characterization of enamel and dentin surfaces after removal of temporary cement--study on removal of temporary cement

Enamel and dentin surfaces of bovine teeth were characterized after mechanical and chemical removal of temporary cements. The surfaces were examined by scanning electron microscopy and X-ray microanalysis. Contact angles of distilled water were measured to monitor surface wettability. Mechanical removal with a dental probe did not completely remove all of the temporary cement from both enamel and dentin surfaces. These surfaces usually produced contact angles of distilled water greater than that on polished surfaces. Etching with thirty-seven percent phosphoric acid effectively removed the temporary cement that remained on enamel surfaces after mechanical removal but the etchant was not effective on dentin surfaces. Acid etching after mechanical removal of cement significantly decreased the contact angles of distilled water on enamel surfaces but the etchant only slightly improved contact angles of distilled water on dentin surfaces.