Switching from eculizumab to satralizumab is safe and may be considered in some patients with neuromyelitis optica spectrum disorder (NMOSD), such as those with antiaquaporin-4 (AQP4) antibody-positive optic neuritis, according to a case study published in the journal Neurological Sciences.

The decision to switch from one treatment to the other depends on the preferences of the patient for drug formulations and dosing intervals or on their background, Kei Funakoshi, of the Dokkyo Medical University in Tochigi, Japan, and colleagues noted.

The research team reported the case of a 74-year-old female who had visual impairment in the right eye that progressed rapidly. She was treated with a series of therapies. Her serum anti-AQP4 antibody was positive, and she had recurrent optic neuritis. She was treated with eculizumab for 21 weeks and then was switched to satralizumab.

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The authors of the study reported no hypersensitivity reactions, or adverse events such as infections, blood cell abnormalities, or liver dysfunction.

The patient continued satralizumab treatment without any recurrence, and 68 weeks later her oral prednisolone was tapered down to 5 mg per day. 

In patients with multiple sclerosis, which is similar to NMOSD, disease activity can increase even more than before the start of treatment if disease-modifying treatments are discontinued. The patient reported here did not experience such an exacerbation upon discontinuing eculizumab. 

“Our patient’s clinical course suggests that a change from [eculizumab] to [satralizumab] can be safe,” the researchers concluded. “To the best of our knowledge, this is the first report of a safe switch from [eculizumab] to [satralizumab].” 

Eculizumab is an anti-C5 monoclonal antibody administered intravenously every 2 weeks. Satralizumab is an anti-interleukin 6 receptor monoclonal antibody that is administered by subcutaneous injection every 4 weeks and requires fewer hospital visits. 


Funakoshi K, Suzuki K. A safe change from eculizumab to satralizumab in a patient with neuromyelitis optica spectrum disorder. Neurol Sci. Published online November 9, 2022. doi:10.1007/s10072-022-06495-w