A new study published in Neurological Sciences has revealed that patients with aquaporin-4-positive (AQP-4 positive) neuromyelitis optica spectrum disorder (NMOSD) can taper prednisolone dose to less than 3 mg/day after receiving satralizumab. The case study found that satralizumab may be an effective option for patients with NMOSD, who want to reduce their steroid burden without compromising their disease control.

The study reported three cases of patients with NMOSD. Patient 1, a 40-year-old female, presented with decreased muscle strength in the bilateral limbs with left dominance and sensory disturbance. She was introduced to satralizumab and could walk 1 km without a cane.

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Patient 2, a 63-year-old female, presented with initial onset, which took the form of nausea and vomiting, followed by a relapse with decreased right visual acuity. After all other treatments failed, she was introduced to satralizumab, which she didn’t report any relapse of NMOSD for more than 2 years.

Patient 3, a 65-year-old female, presented with left optic neuritis. Satralizumab was introduced nine months after the initial symptom onset. For this patient, prednisolone was tapered from 10 mg/day at a rate of 1 mg/week, to 3 mg/day over 28 weeks. The patient reported no relapse for 7 months after starting satralizumab.

None of the 3 patients experienced relapses or adverse events during the tapering process. The patients started satralizumab treatment and successfully tapered their prednisolone dose from 10 mg/day to less than 3 mg/day within 1 year. This result suggests a significant effect in preventing relapse due to the introduction of satralizumab.

“In our 3 patients, prednisolone was ultimately reduced to ≤ 3 mg/day after starting administration of satralizumab, and continued with no relapses of NMOSD,” the authors highlighted. The timing and pace of prednisolone tapering with satralizumab is critical and depends on multiple factors such as disease duration, severity, and activity.

Neuromyelitis optica spectrum disorder is a rare and severe autoimmune disease of the central nervous system. It is characterized by recurrent attacks of optic neuritis and transverse myelitis, which can lead to blindness and paralysis.

Prednisolone is a steroid that can prevent relapses of NMOSD, but it has many side effects, such as diabetes, osteoporosis, and mental disorders. Therefore, reducing the dose of prednisolone is desirable for patients with NMOSD.

Satralizumab is a monoclonal antibody that blocks the interleukin-6 receptor, a molecule involved in inflammation and autoimmunity. It was approved in Japan in 2019 as an add-on therapy for patients with NMOSD who are positive for the anti-aquaporin-4 antibody.


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