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Neuromyelitis Optica (NMOSD) Treatments Compared

4 FDA-approved drugs, plus 2 in development, side by side from the current prescribing labels. Newest label Jul 2026. Checked October 23, 2026.

The full Neuromyelitis Optica guide, with open trials and help paying →

Complement C5 inhibitorsSoliris · Ultomiris
CD19 B-cell depletionUplizna
IL-6 receptor blockerEnspryng

Four medicines are FDA-approved to prevent relapses of neuromyelitis optica spectrum disorder (NMOSD), and all 4 are for adults who test positive for anti-aquaporin-4 (AQP4) antibodies. Soliris and Ultomiris block complement protein C5, Uplizna removes B cells that carry CD19, and Enspryng blocks the interleukin-6 receptor. Soliris, Ultomiris and Uplizna are clinic infusions, while Enspryng is a shot under the skin every 4 weeks that can be given at home. Soliris and Ultomiris carry a boxed warning for serious meningococcal infections and require vaccination; Bkemv and Epysqli, biosimilar versions of Soliris, are also approved for AQP4-positive adults. Every pivotal trial measured the time to a first relapse, but the designs and comparison groups differed, so the relapse numbers do not rank the drugs.

Side by side

4 approved NMOSD treatments at a glance

How each drug is given, how often, who it is approved for and when it was first approved, from the current FDA label.

Neuromyelitis Optica treatments compared: route, schedule, approved use and approval date
DrugHow it is givenHow oftenApproved forFirst approved
eculizumab
Alexion (AstraZeneca)
IV infusion at a clinic every 2 weeksAbout 35 minutes per dose900 mg weekly for 4 weeks, then 1,200 mg at week 5, then 1,200 mg every 2 weeksAdults with NMOSD who are anti-AQP4 antibody positiveJune 27, 2019
ravulizumab-cwvz
Alexion (AstraZeneca)
IV infusion at a clinic every 8 weeksWeight-based loading dose (2,400 to 3,000 mg), then a maintenance dose (3,000 to 3,600 mg) 2 weeks later and every 8 weeks after that; for adults 40 kg and overAdults with NMOSD who are anti-AQP4 antibody positiveMarch 22, 2024
inebilizumab-cdon
Amgen
IV infusion at a clinic, about 90 minutes, twice a year after 2 starting dosesAbout 90 minutes per dose300 mg, a second 300 mg dose 2 weeks later, then 300 mg every 6 months, with a steroid, antihistamine and fever reducer before each infusionAdults with NMOSD who are anti-AQP4 antibody positiveJune 11, 2020
satralizumab-mwge
Genentech (Roche), developed by Chugai
Shot under the skin every 4 weeks, self-injected at home after training120 mg at weeks 0, 2 and 4, then 120 mg every 4 weeks, from a prefilled syringe or autoinjectorAdults with NMOSD who are anti-AQP4 antibody positiveAugust 14, 2020
The calendar

A year on each NMOSD treatment

Every dose in a year, drawn to the label schedule, so you can see at a glance how often each one is given.

Soliris
Infusion, at a clinic
26 doses a year
Ultomiris
Infusion, at a clinic
Weight-based loading dose (2,400 to 3,000 mg), then a maintenance dose (3,000 to 3,600 m... (no fixed yearly count)
Uplizna
Infusion, at a clinic
2 doses a year
Enspryng
Injection, at home
13 doses a year

Counts follow the label schedule for a full year on the maintenance dose. Drugs given in cycles or adjusted to blood tests have no fixed count, so their schedule is written out instead.

The evidence

What the pivotal NMOSD trials showed

The primary result from the trial each FDA approval rests on, as reported on the label.

Neuromyelitis Optica pivotal trial results by drug
DrugPivotal trialPrimary result
eculizumab
Alexion (AstraZeneca)
PREVENT (NCT01892345), 143 AQP4-positive adults, against placebo; 76% also stayed on immunosuppressants or steroids
Trial record or paper		Relapse risk 94% lower than placebo (hazard ratio 0.058); 3 relapses on Soliris vs 21 on placebo
ravulizumab-cwvz
Alexion (AstraZeneca)
CHAMPION-NMOSD (NCT04201262), 58 AQP4-positive adults, open label with no placebo group of its own; compared with the PREVENT placebo group
Trial record or paper		No adjudicated relapses in 58 patients over a median 73.5 weeks; relapse risk 98.6% lower than the external placebo group (hazard ratio 0.014)
inebilizumab-cdon
Amgen
N-MOmentum (NCT02200770), 213 AQP4-positive adults, against placebo, with other immunosuppressants and steroids not allowed
Trial record or paper		11.2% relapsed by day 197 (about 28 weeks) vs 42.3% on placebo; relapse risk 77.3% lower (hazard ratio 0.227)
satralizumab-mwge
Genentech (Roche), developed by Chugai
SAkuraStar (NCT02073279), Enspryng alone, 64 AQP4-positive adults; SAkuraSky (NCT02028884), added to azathioprine, mycophenolate or steroids, 52 AQP4-positive adults; each against placebo
Trial record or paper		Alone: 22% relapsed vs 56.5% on placebo, relapse risk 74% lower. Added on: 11.5% vs 42.3%, relapse risk 78% lower
Safety

Neuromyelitis Optica treatment side effects and warnings

Soliris and Ultomiris carry a boxed warning, the FDA's strongest. The rest list their main precautions. Side effect rates show how many people in each drug's trials reported each one, whether or not the drug caused it.

Neuromyelitis Optica treatments: most common side effects and key warnings from the FDA labels
DrugMost common side effectsKey warning
eculizumab
Alexion (AstraZeneca)
upper respiratory infection 29% vs 13% on placebo, common cold symptoms 21% vs 19% and diarrhea 16% vs 15%Boxed warning Boxed warning: serious meningococcal infections. Meningococcal vaccination required at least 2 weeks before the first dose; available only through a REMS program.
ravulizumab-cwvz
Alexion (AstraZeneca)
COVID-19 24%, headache 24% and back pain 12%Boxed warning Boxed warning: serious meningococcal infections. Meningococcal vaccination required at least 2 weeks before the first dose; available only through a REMS program.
inebilizumab-cdon
Amgen
urinary tract infection 11% vs 10% on placebo, joint pain 10% vs 4% and back pain 7% vs 4%No boxed warning. Infusion reactions (premedication required), serious infections including hepatitis B reactivation and PML, low immunoglobulin levels, and possible harm to an unborn baby. Hepatitis B, tuberculosis and immunoglobulin tests before the first dose.
satralizumab-mwge
Genentech (Roche), developed by Chugai
common cold symptoms 31% vs 15% on placebo (add-on trial), headache 27% vs 12% (add-on trial) and rash 17% vs 0% (trial of Enspryng alone)No boxed warning. Serious infections, raised liver enzymes and low neutrophil counts. Hepatitis B, tuberculosis and liver tests before the first dose; liver tests every 4 weeks for 3 months, then every 3 months for 1 year.
Not yet approved

NMOSD treatments in clinical trials

Investigational drugs in Phase 1 to 3 trials shown separately because their results are not from an FDA label. Status as of the date in each row.

Neuromyelitis Optica drugs not FDA-approved
DrugStatusHow it works and is givenPivotal trialResult so farWhat is next
Phase 3as of October 23, 2026Long-acting complement C5 inhibitor, already approved for AQP4-positive adultsIV infusion, dose based on body weightNCT05346354, Phase 2/3, open label, single arm, 12 children and teens with AQP4-positive NMOSD, compared with historical dataPrimary endpoint: Change in annualized relapse rate and time to first adjudicated relapse through week 50
ClinicalTrials.gov		No trial results published yetPrimary completion estimated June 22, 2026 on ClinicalTrials.gov; no results posted as of October 23, 2026
ClinicalTrials.gov NCT05346354, updated June 24, 2026
Phase 2as of October 23, 2026CD19 B-cell depleting antibody, already approved for AQP4-positive adultsIV infusionNCT05549258, open label, about 15 children and teens aged 2 to 17 with NMOSDPrimary endpoint: Blood levels of inebilizumab over the first 28 weeks
ClinicalTrials.gov		No trial results published yetPrimary completion estimated April 13, 2027 on ClinicalTrials.gov
ClinicalTrials.gov NCT05549258, updated December 5, 2025
Cost

Help paying for NMOSD treatment

Drugmaker copay and free-drug programs, plus charity funds for the condition, checked every week.

Assistance finderEvery program and fund for Neuromyelitis Optica, filtered by your insuranceAlexion (AstraZeneca)Soliris patient support programAlexion (AstraZeneca)Ultomiris patient support programAmgenUplizna patient support programGenentech (Roche), developed by ChugaiEnspryng patient support program
Insurance said no? Your Insurer Denied a Rare Disease Drug and Fewer Than 1 in 100 People Appeal, So Here Is the Playbook · 14 min read
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Questions

Neuromyelitis Optica treatment questions people ask

Soliris vs Ultomiris for NMOSD: what is the difference?

Both block complement protein C5 and come from the same company, Alexion; Ultomiris is the longer-acting version.

Who it is for: Both are approved for adults with NMOSD who are anti-AQP4 antibody positive.

How it is given: Soliris is an IV infusion every 2 weeks after 5 weekly starting doses, about 35 minutes each in adults. Ultomiris is an IV infusion every 8 weeks after a weight-based loading dose and a first maintenance dose 2 weeks later.

Safety: Both carry a boxed warning for serious meningococcal infections, require meningococcal vaccination at least 2 weeks before the first dose unless waiting is riskier, and are available only through a REMS program.

Trial results: Soliris lowered the risk of relapse 94% against placebo in PREVENT. No Ultomiris patient had an adjudicated relapse in CHAMPION-NMOSD over a median 73.5 weeks, a 98.6% lower risk than the PREVENT placebo group. That comparison used a placebo group from another trial, so the 2 numbers do not show that one works better.

More: Soliris drug page and Ultomiris drug page

Source: FDA label for Soliris, DailyMed, effective July 2026; FDA label for Ultomiris, DailyMed, effective October 2025

Uplizna vs Enspryng for NMOSD: what is the difference?

Uplizna removes B cells that carry CD19, the cells that make the harmful antibodies, while Enspryng blocks the receptor for interleukin-6, an immune messenger that drives inflammation.

How it is given: Uplizna is a clinic IV infusion of about 90 minutes, with 2 starting doses 2 weeks apart and then 1 dose every 6 months. Enspryng is a shot under the skin at weeks 0, 2 and 4 and then every 4 weeks, which patients or caregivers can give at home after training.

Safety: Neither has a boxed warning. Uplizna's label warns about infusion reactions, serious infections, low antibody levels and harm to an unborn baby. Enspryng's label warns about serious infections, raised liver enzymes and low neutrophil counts, with liver tests every 4 weeks for the first 3 months.

Trial results: In N-MOmentum, 11.2% of AQP4-positive patients on Uplizna relapsed by about week 28 against 42.3% on placebo. Enspryng lowered relapse risk 74% when taken alone and 78% when added to other treatment, in 2 smaller trials. The trials differed in length and design, so the numbers cannot be ranked.

More: Uplizna drug page and Enspryng drug page

Source: FDA label for Uplizna, DailyMed, effective December 2025; FDA label for Enspryng, DailyMed, effective June 2026

Which NMOSD treatment works best?

No completed trial has compared the 4 approved drugs with each other, so there is no evidence that one works better for everyone.

What the trials show: In randomized trials against placebo, each drug lowered relapse risk by 74% to 94%. Ultomiris's 98.6% was measured against a placebo group borrowed from another trial, and the trials differed in length and background treatments.

What usually decides it: How often you can get to an infusion center: every 2 weeks for Soliris, every 8 weeks for Ultomiris and twice a year for Uplizna. Enspryng is a shot at home every 4 weeks. Whether meningococcal vaccination and the infection risk of complement blockers fit your situation. Other health conditions, pregnancy plans and the blood tests each drug needs.

What is being studied: A Phase 4 trial led by Massachusetts General Hospital, NCT07010302, is randomly assigning AQP4-positive adults to rituximab or one of the approved drugs.

Next step: The table on this page puts all 4 side by side for that conversation with your neurologist.

Source: FDA label for Soliris, DailyMed; FDA label for Ultomiris, DailyMed; FDA label for Uplizna, DailyMed; FDA label for Enspryng, DailyMed; ClinicalTrials.gov NCT07010302

Which NMOSD drugs have a boxed warning?

Soliris and Ultomiris, the 2 complement blockers, and the Soliris biosimilars Bkemv and Epysqli carry a boxed warning for serious meningococcal infections, which can become life threatening quickly.

What it means for you: Meningococcal vaccines are completed or updated at least 2 weeks before the first dose unless waiting is riskier. The drugs are available only through a REMS safety program, and the risk stays raised even after vaccination.

The other 2: Uplizna and Enspryng have no boxed warning. Their labels warn about serious infections and require hepatitis B and tuberculosis screening before the first dose.

More: Soliris drug page and Ultomiris drug page

Source: FDA label for Soliris, DailyMed, effective July 2026; FDA label for Ultomiris, DailyMed, effective October 2025

Are rituximab, azathioprine or mycophenolate approved for NMOSD?

No. None of the 3 is FDA-approved for NMOSD, and any use for it is off label, decided by a doctor.

What the evidence shows: In RIN-1, a small Japanese trial of 38 AQP4-positive patients, none on rituximab relapsed over 72 weeks against 7 of 19 on placebo. In the Enspryng add-on trial, SAkuraSky, patients stayed on azathioprine, mycophenolate or steroids as background treatment.

What is being studied: NCT07010302, a Phase 4 trial that started in September 2026, compares rituximab with the 4 approved drugs.

More: NMOSD clinical trials

Source: Tahara et al., RIN-1, Lancet Neurology 2020, PubMed; FDA label for Enspryng, DailyMed; ClinicalTrials.gov NCT07010302

Is there an NMOSD treatment approved for children?

Not yet. All 4 labels cover adults only, and the Soliris, Uplizna and Enspryng labels say safety and effectiveness in children have not been established.

What is being studied: Ultomiris has a Phase 2/3 study in 12 children and teens that has finished enrolling (NCT05346354). Enspryng's SAkuraSun study is enrolling children aged 2 to 11 (NCT05199688), and Uplizna has a study in ages 2 to 17 (NCT05549258). An earlier Soliris study in children was stopped because it was not feasible.

More: NMOSD clinical trials

Source: ClinicalTrials.gov NCT05346354; ClinicalTrials.gov NCT05199688; ClinicalTrials.gov NCT05549258; ClinicalTrials.gov NCT04155424

Do these drugs treat MOG antibody disease (MOGAD)?

Not yet. MOGAD is a separate condition, and none of the 4 NMOSD drugs is FDA-approved for it.

Under FDA review: Genentech says the FDA will decide on Enspryng for MOGAD by January 10, 2027. In its Phase 3 METEOROID trial, Genentech reports that Enspryng lowered relapse risk 68% against placebo.

In trials: UCB's rozanolixizumab is in the Phase 3 cosMOG trial in adults with MOGAD (NCT05063162).

More: Enspryng drug page

Source: Genentech, September 9, 2026; ClinicalTrials.gov NCT05063162

Go deeper

More on Neuromyelitis Optica at Trial Friend

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Sources

Where every number on this page comes from

Approved-drug facts are from the current FDA prescribing information on DailyMed, with the label's effective date. Investigational-drug facts are from ClinicalTrials.gov and the sources named in each row.

  1. Soliris (eculizumab) prescribing information, Alexion (AstraZeneca), label dated Jul 2026. DailyMed. Pivotal trial: ClinicalTrials.gov
  2. Ultomiris (ravulizumab-cwvz) prescribing information, Alexion (AstraZeneca), label dated Oct 2025. DailyMed. Pivotal trial: ClinicalTrials.gov
  3. Uplizna (inebilizumab-cdon) prescribing information, Amgen, label dated Dec 2025. DailyMed. Pivotal trial: ClinicalTrials.gov
  4. Enspryng (satralizumab-mwge) prescribing information, Genentech (Roche), developed by Chugai, label dated Jun 2026. DailyMed. Pivotal trial: ClinicalTrials.gov
  5. Ultomiris (ravulizumab) for children and teens, Alexion (AstraZeneca): ClinicalTrials.gov record; ClinicalTrials.gov NCT05346354, updated June 24, 2026. Checked October 23, 2026.
  6. Uplizna (inebilizumab) for children and teens, Amgen: ClinicalTrials.gov record; ClinicalTrials.gov NCT05549258, updated December 5, 2025. Checked October 23, 2026.

This page compares what the FDA labels and pivotal trials report. It is not medical advice, and no trial on this page compared these drugs with each other. Written and checked by Jason Hunter; the method is on the editorial standards page.