Abstract
Background: Satralizumab is approved for aquaporin-4 immunoglobulin G-positive (AQP4-IgG+) neuromyelitis optica spectrum disorder (NMOSD), but real-world data are limited. This case series aimed to describe real-world experiences with satralizumab in adults with AQP4-IgG+ NMOSD. Methods: Case information for patients with AQP4-IgG+ NMOSD who received satralizumab for ≥6 months was obtained from US healthcare providers over 28 months. Patient characteristics, examination findings, diagnostic tests, treatment responses, and adverse events were recorded. Results: Of 43 patients, 88% were female and 44% self-identified as Black. Median age was 54 (range, 20-82) years, and time since confirmed NMOSD diagnosis was 8 (1-18) years. Reasons for satralizumab initiation included intolerance/safety concerns with existing therapy (30%), new diagnosis (26%), and inadequate disease control (21%). The median duration of satralizumab treatment was 31 (range, 7-104) months, during which three patients (7%) had radiographically confirmed relapses and 15 (35%) experienced a related adverse event. At data cutoff, 35 patients (81%) were receiving satralizumab. Conclusion: Satralizumab was effective and well tolerated in patients with NMOSD, including those who switched from previous treatments due to inadequate disease control and/or intolerance. These real-world outcomes align with long-term safety and efficacy findings from the Phase III SAkura trials.