{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T04:54:40Z","timestamp":1791262480003,"version":"4.1.0"},"reference-count":25,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T00:00:00Z","timestamp":1791244800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Neuromyelitis optica spectrum disorder (NMOSD) is a neuroimmunological astrocytopathy mediated by anti-aquaporin-4 (AQP4-IgG) antibodies that trigger complement-dependent cytotoxicity and activation of the terminal complement cascade in the central nervous system. Ravulizumab, a long-acting terminal complement C5 inhibitor, received regulatory approval in Chile in January 2025; the seven patients reported here represent the entire nationally treated cohort to date.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To describe the first clinical experience with ravulizumab in NMOSD at three Chilean centers (Cl\u00ednica Alemana de Santiago, a private center, Cl\u00ednica D\u00e1vila, a private center, and Hospital Cl\u00ednico Universidad de Chile, a public university hospital).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Retrospective, multicenter cohort study of patients with NMOSD fulfilling the 2015 International Panel for NMO Diagnosis (IPND) consensus criteria who were receiving ravulizumab. Demographic and clinical characteristics, AQP4-IgG status, baseline and follow-up Expanded Disability Status Scale (EDSS) scores, treatment indication, relapses and adverse events were analyzed through medical chart review.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Seven patients (100% female) were included, with a mean age at disease onset of 51.0 years (range 38\u201369). AQP4-IgG was positive in all patients (100%), confirmed by cell-based assay. The most common presentation over the disease course was longitudinally extensive transverse myelitis (LETM; 7\/7); four patients (57.1%) also developed optic neuritis. Median baseline EDSS was 6.0. Five patients had previously failed rituximab, one discontinued rituximab because of active cancer, and one was treatment na\u00efve. Over a median follow-up of 15 months (range 4\u201324) on ravulizumab, no clinical relapses were observed (0\/7 patients), compared with approximately 4.5 relapses expected across the cohort\u2019s person-time had the pre-treatment relapse rate continued unchanged (observed-vs-expected analysis; see Results). EDSS declined from a baseline median of 6.0 to 2.5 (median within-patient change 1.5 points, IQR 1.0\u20134.0); because baseline EDSS in several patients was recorded during or shortly after an acute attack, this decrease likely reflects post-attack recovery in addition to any disability-modifying effect, and three patients remained at EDSS \u22655. Headache was the only adverse event (7\/7), mild to moderate and self-limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this real-world Chilean cohort, ravulizumab was associated with complete relapse suppression over a median follow-up of 15 months and was well tolerated. These preliminary, uncontrolled observations are consistent with the relapse-prevention efficacy reported in pivotal trials and with regional consensus guidance on its use after rituximab failure, and they underscore the need to expand equitable access to complement-targeted therapies within the Chilean healthcare system.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fimmu.2026.1932448","type":"journal-article","created":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T04:26:38Z","timestamp":1791260798000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Ravulizumab in neuromyelitis optica spectrum disorder: first clinical experience in Chile"],"prefix":"10.3389","volume":"17","author":[{"given":"Tamara","family":"Santib\u00e1\u00f1ez","sequence":"first","affiliation":[{"name":"Neuroimmunology Unit, Department of Neurology, Cl\u00ednica Alemana de Santiago","place":["Santiago, Chile"]},{"name":"Hospital Dra. Elo\u00edsa D\u00edaz Inzunza, La Florida","place":["Santiago, Chile"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9 Miguel","family":"Vald\u00e9s","sequence":"additional","affiliation":[{"name":"Neuroimmunology Unit, Department of Neurology, Cl\u00ednica Alemana de Santiago","place":["Santiago, Chile"]},{"name":"Cl\u00ednica RedSalud","place":["Santiago, Chile"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C\u00e9sar","family":"Romero","sequence":"additional","affiliation":[{"name":"Cl\u00ednica RedSalud","place":["Santiago, Chile"]},{"name":"Hospital Cl\u00ednico Universidad de Chile","place":["Santiago, Chile"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manuel","family":"Fruns","sequence":"additional","affiliation":[{"name":"Cl\u00ednica Universidad de los Andes","place":["Santiago, Chile"]},{"name":"Cl\u00ednica Las Condes","place":["Santiago, Chile"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorna","family":"Galleguillos","sequence":"additional","affiliation":[{"name":"Neuroimmunology Unit, Department of Neurology, Cl\u00ednica Alemana de Santiago","place":["Santiago, Chile"]},{"name":"Cl\u00ednica D\u00e1vila","place":["Santiago, Chile"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,10,6]]},"reference":[{"key":"B1","article-title":"My\u00e9lite subaigu\u00eb compliqu\u00e9e de n\u00e9vrite optique","volume":"8","author":"Devic","year":"1894","journal-title":"Bull Med (Paris)"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(04)17551-x","article-title":"A serum autoantibody marker of neuromyelitis optica: distinction from multiple 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