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.
Competing Interests: HA: 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. Served as an assistant editor for the Neurology Journal. Receives royalties from UpToDate. AS: Speaker for TG Therapeutics, Bristol Myers Squibb. BS: Served on advisory boards for Genentech, EMD Serono, and Horizon. Dr. Sengul has received personal compensation for serving on speakers bureaus for Biogen and EMD Serono and served on the steering committee for EMD Serono. RS: Received personal compensation as a consultant or speaker for Alexion, Biogen, Bristol Myers Squibb, EMD Serono, Genentech, Horizon, Novartis, Sanofi Genzyme, and TG Therapeutics. PG, RW, JC, and RP: Consultant for Genentech/Roche, Bristol Myers Squibb, Sanofi, Horizon, Alexion. Speakers bureau for Alexion, Horizon, Biogen, Bristol Myers Squibb, EMD Serono. The institution of Drs. Walch, Goulette, Cote, and Pace has received research support from Genentech/Roche, Sanofi, EMD Serono, and Novartis. Research support from TG Therapeutics. AO: Speaker or consultant for Alexion Pharmaceuticals, Amgen, Banner Life Sciences, BD Biosciences, Biogen, Biologix, Bristol Myers Squibb, Celgene, EMD Serono, Genentech, Inc., GW Pharma, Jazz Pharmaceuticals, Horizon Therapeutics, Novartis, Sandoz Pharmaceuticals, Sanofi/Genzyme, TG Therapeutics, and Viela Bio and honoraria from Medscape, WebMD, and MJH Life Sciences. LF and SG: Employees of Genentech, Inc., and shareholders in F. Hoffmann-La Roche Ltd.
(Copyright © 2025 Abboud, Subei, Sengul, Shin, Goulette, Walch, Coté, Pace, Obeidat, Ferayorni and Gholizadeh.)