Meningococcal Vaccination Recommended Before Switch to Ravulizumab in NMOSD

Patients with anti-aquaporin-4 antibody-positive neuromyelitis optica spectrum disorder (AQP4-Ab+ NMOSD) who discontinue rituximab receive meningococcal vaccinations within 6 months before initiating ravulizumab, according to study results presented at the Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS) Forum 2025, held in West Palm Beach, Florida from February 27 to March 1.

Researchers conducted a post-hoc analysis of the CHAMPION-NMOSD trial (ClinicalTrials.gov Identifier: NCT04201262) to assess the timing of meningococcal vaccination in patients transitioning from rituximab to ravulizumab. Eligible participants had received rituximab before switching therapies and underwent meningococcal vaccination (MenACWY or MenB) after discontinuation.

The primary outcome was the time from the last rituximab dose to the first administered meningococcal vaccine. Secondary outcomes included the proportion of patients receiving both MenACWY and MenB at the same visit, total lymphocyte counts at vaccination, and the incidence of meningococcal infection or NMOSD relapse.

Among 19 patients included in the post-hoc analysis, 68.4% were vaccinated within 6 months of rituximab discontinuation, with 15.8% receiving their first vaccine within 3 months and 52.6% between 3 and 6 months. Most patients (84.2%) received both MenACWY and MenB at the same visit, and 21.0% required multiple doses of either vaccine.

Total lymphocyte counts were within normal limits for 92.3% of tested patients. No cases of meningococcal infection or NMOSD relapse were reported following vaccination.

“Most patients received a meningococcal vaccination ≤6 months after their last dose of rituximab, with MenACWY and MenB vaccines at the same visit,” the researchers concluded.