The interleukin-6 (IL-6) receptor inhibitors tocilizumab and satralizumab showed promising efficacy and acceptable safety profiles for the treatment of neuromyelitis optica spectrum disorder (NMOSD), according to a new review article.

The study, published in BMC Neurology, analyzed the results of 9 published studies with a total of 202 patients. They found that 76% of patients (P <.001) given tocilizumab were relapse-free at follow-up. There was also a decrease of 2.6 (P <.001) in annualized relapse rate (ARR) in this group. No significant decrease in the Extended Disability Status Scale (EDSS; P =.16) was observed, however.

“Our meta-analysis showed tocilizumab has significant benefits in reducing mean ARR and increasing the number of relapse-free patients with acceptable adverse events profiles,” the authors wrote. “The similar efficacy outcomes and favorable safety profiles were found for satralizumab in two trials.”

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Only 2 trials were found for satralizumab, one as monotherapy and one in combination with immunosuppressants, so they were not included in the meta-analysis. The trials showed reductions in relapses compared to patients receiving placebo (20% vs 43% in one trial and 30% vs 50% in the other). The patients also showed decreases in ARR when treated with satralizumab as well as improvements in EDSS scores.

In the tocilizumab trials, 56% of patients experienced adverse events. In observational studies, 48% of patients reported adverse events in comparison to 97% of patients in randomized clinical trials. In total, 198 adverse events were reported across the 9 trials, with the most common events being upper respiratory tract infections, urinary tract infections, hypercholesterolemia, leucopenia, fatigue, and anemia.

The most common serious adverse events reported in the studies were bacterial infections including pneumonia and deep vein thrombosis. A total of 2 deaths were reported across all trials but were not related to treatment complications. One patient died from cervical myelitis while the other experienced a relapse of longitudinally extensive transverse myelitis.


Kharel S, Shrestha S, Ojha R, Guragain N, Ghimire R. Safety and efficacy of interleukin-6-receptor inhibitors in the treatment of neuromyelitis optica spectrum disorders: a meta-analysis. BMC Neurol. 2021;21(1):458. doi:10.1186/s12883-021-02488-y