Switch from eculizumab to satralizumab in aquaporin 4 immunoglobulin G-seropositive neuromyelitis optica spectrum disorder: a case series report.

Objectives: This case series describes adults with aquaporin 4 immunoglobulin G-seropositive (AQP4-IgG+) neuromyelitis optica spectrum disorder (NMOSD) who switched treatment from eculizumab to satralizumab. Methods: Case information for patients with AQP4-IgG+ NMOSD who received satralizumab for ≥6 months was obtained from US healthcare providers from April 2022 to January 2024. Patient characteristics, examination findings, diagnostic test results, treatment response, and adverse events were recorded. Results: Among the 5 patients (4 women and 1 man) included, ages ranged from 32 to 81 years and 4 patients self-identified as Black/African American and 1 as White. Time since confirmed NMOSD diagnosis ranged from 1 to 14 years. The reasons for initiating satralizumab were route of administration/patient preference (n=3) and inadequate disease control with eculizumab (n=2). The duration of satralizumab treatment was 10 to 31 months. All 5 patients were relapse-free with satralizumab, and adverse events they experienced were primarily asymptomatic laboratory abnormalities. Discussion: In this retrospective case series, satralizumab was effective and well tolerated in patients with NMOSD who switched from eculizumab due to route of administration/patient preference or inadequate disease control. These outcomes align with the long-term efficacy and safety outcomes with satralizumab in the phase 3 SAkura clinical trials.