Researchers from Japan reported the case of 3 patients with aquaporin-4-positive neuromyelitis optica spectrum disorder (AQP4+NMOSD) whose prednisolone dose was rapidly and successfully tapered down following satralizumab treatment.
The rapid prednisolone tapering method described here seems adequate, and the data suggests that satralizumab may be an effective monotherapy for the treatment of NMOSD.
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The study was published in the journal Neurological Sciences.
Monotherapy with prednisolone can prevent relapses in NMOSD but only at doses of 10 mg or more per day. However, at these high doses, the treatment can lead to a multitude of side effects, including diabetes, hyperlipidemia, osteoporosis, and obesity.
The method and speed of steroid tapering are decided on a case-by-case basis. The tapering method described here was faster than reported earlier.
For the first patient, it was started 8 weeks after the start of satralizumab and reduced by 1 mg per week from 10 mg per day down to 0 over 40 weeks, while for the second patient, it was reduced from 30 mg per day at the same time and same pace down to discontinuation after 100 weeks. Finally, for the third patient, the dose of prednisolone was tapered from 10 mg per day to 3 mg per day over 28 weeks after the initiation of satralizumab.
NMOSD relapses are usually common with prednisolone treatment of 10 mg per day or less. However, none of the 3 patients reported here relapsed following prednisolone tapering, suggesting that satralizumab may contribute to the prevention of relapses.
In a previous clinical trial, satralizumab treatment was also shown to reduce the risk of relapse compared to placebo when prednisolone was tapered. However, in this study, tapering was started before satralizumab treatment was started. The researcher said that further decreases might have been achievable in that trial using their tapering protocol. “. . . the present results indicate that the timing for the start of tapering may be more important than the pace,” they wrote.
Satralizumab is an interleukin 6 receptor antagonist that has been approved by the US Food and Drug Administration for the treatment of patients with AQP4+NMOSD and is sold under the brand name Enspryng®.
Reference
Nakamagoe K, Tanaka M, Igari K. Cases of aquaporin-4-positive neuromyelitis optica spectrum disorder with successful tapering of prednisolone to less than 3 mg/day after satralizumab administration. Neurol Sci. Published online March 18, 2023. doi:10.1007/s10072-023-06754-4
