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. 2025 Jun 15:403:578585.
doi: 10.1016/j.jneuroim.2025.578585. Epub 2025 Mar 16.

Satralizumab treatment in patients with AQP4-IgG-seropositive neuromyelitis optica spectrum disorder after rituximab treatment: A case series

Hesham Abboud  1 , Brian Steingo  2 , Diana Vargas  3 , Julie Patel  4 , Nancy Nealon  5 , Mary Alissa Willis  6 , Yang Mao-Draayer  7 , Dmitry Khaitov  8 , Michelle Tsai  9 , Angie Kim  10 , Krupa Pandey  11 , Michael Levy  12 , Negar Molazadeh  13 , Rebecca S Romero  14 , Lisa Ferayorni  15 , Shervin Gholizadeh  16
Affiliations
Free article

Satralizumab treatment in patients with AQP4-IgG-seropositive neuromyelitis optica spectrum disorder after rituximab treatment: A case series

Hesham Abboud et al. J Neuroimmunol. .
Free article

Abstract

Background: The US Food and Drug Administration approved satralizumab for use in adult patients with aquaporin-4 immunoglobulin G-positive (AQP4-IgG+) neuromyelitis optica spectrum disorder (NMOSD) in 2020, but real-world data are limited. The objective of this case series is to describe the experience with satralizumab in adult patients with AQP4-IgG+ NMOSD who previously received rituximab.

Methods: Case information for patients with AQP4-IgG+ NMOSD who had received satralizumab for ≥6 months was obtained from US healthcare providers from April 1, 2022, to September 30, 2023. Patient characteristics, examination findings, diagnostic tests, treatment response and adverse events were recorded. Patients who received satralizumab after discontinuing treatment with rituximab were included in this case series.

Results: Twenty patients were included, and their ages ranged from 19 to 70 years. Overall, 45 % of patients self-identified as Black/African American, 40 % as White, 10 % as Asian and 5 % as multiracial. Time since confirmed NMOSD diagnosis ranged from 4 to 17 years. Median (range) duration of rituximab treatment was 50 (12-162) months. The main reasons for switching to satralizumab were intolerance (60 %) to and inadequate disease control (25 %) with rituximab. The majority of patients (70 %) received satralizumab for ≥24 months and as monotherapy (90 %). All 20 patients were free from radiographically confirmed relapses with satralizumab. Overall, patients maintained disease control with satralizumab, and adverse events primarily included asymptomatic laboratory abnormalities. Two patients permanently discontinued satralizumab due to adverse events.

Conclusions: In this retrospective case series, satralizumab was effective and well tolerated in patients with NMOSD who switched due to ineffectiveness and/or poor tolerability of rituximab. These outcomes align with the long-term efficacy and safety outcomes with satralizumab in the Phase III SAkura clinical trials.

Keywords: Case series; Neuromyelitis optica spectrum disorder; Real-world data; Rituximab; Satralizumab.

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Conflict of interest statement

Declaration of competing interest H. Abboud: Consultant for Biogen, Genentech, Inc., Bristol Myers Squibb, Alexion, Horizon, Cycle Pharma and Alpine Pharma. Receives research support from Novartis, Sanofi-Genzyme, Bristol Myers Squibb, Genentech, Inc., UCB and the Guthy-Jackson Charitable Foundation. Serves as an assistant editor for the Neurology Journal. B. Steingo: Honoraria/speaker and research fees from Biogen, Sanofi, EMD Serono, Novartis, Janssen, Bristol Myers Squibb and Genentech, Inc. (advisory board). D. Vargas: Nothing to disclose. J. Patel: Nothing to disclose. N. Nealon: Nothing to disclose. M.A. Willis: Consultant for Genentech, Inc., speaker for Alexion and research support from Alexion. Y. Mao-Draayer: Consultant and/or received grant support from Acorda, Bayer, Biogen Idec, Celgene/Bristol Myers Squibb, EMD Serono, Sanofi-Genzyme, F. Hoffmann-La Roche Ltd/Genentech, Inc., Janssen, Novartis, Questor and Teva Neuroscience and was supported by grants from National Institutes of Health National Institute of Allergy and Infectious Diseases Autoimmune Center of Excellence (UM1-AI110557-05, UM1 AI144298-01), Chugai, Patient-Centered Outcomes Research Institute, Novartis, Sanofi-Genzyme and Genentech, Inc.D. Khaitov: Speaker for Biogen. M. Tsai: Nothing to disclose. A. Kim: Nothing to disclose. K. Pandey: Consultant for BMS, Sanofi Genzyme and Genentech, Inc. Dr. Pandey has received personal compensation for serving on speakers bureaus for BMS, Biogen, Genentech, Inc., Sanofi-Genzyme and Horizon Therapeutics. The institution of Dr. Pandey has received research support from National Institutes of Health and Consortium of Multiple Sclerosis Centers. M. Levy: Consultant for Alexion, AstraZeneca Rare Disease, Viela Bio and Genentech/Roche/Chugai. In addition, he has received consulting fees from Quest Diagnostics, Mitsubishi and UCB Pharmaceuticals. N. Molazadeh: The institution of Dr. Molazadeh has received research support from Genentech, Inc.R.S. Romero: Consultant for BMS, Viela Bio, Genentech, Inc., Alexion and Horizon. L. Ferayorni and S. Gholizadeh: Employees of Genentech, Inc., and shareholders in F. Hoffmann-La Roche Ltd.

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