Treatment for neuromyelitis optica spectrum disorder (NMOSD) should be tailored for each patient to prevent severe adverse events, according to a study recently published in Internal Medicine Advanced Publication

“Our data demonstrated that sepsis could be life-threatening to NMOSD patients administered satralizumab and to RA patients administered tocilizumab, sometimes rapidly occurring after the initiation of treatment,” the authors wrote. 

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This case series described 6 different female patients previously diagnosed with NMOSD who began treatment with satralizumab and developed sepsis as a complication of the therapeutic scheme. Almost all (83%) had a urinary tract infection as the primary infectious source. 

Notably, all cases had at least 2 clear risk factors, such as being 50 years of age or older, present in all 6 patients. Five also received treatment with corticosteroids, while the other patient did not have such data reported.

The majority (75% of whom the data was available) had diabetes or impaired glucose tolerance and/or abnormal body mass index (BMI), either overweight (>25) or emancipated (<18.5). Likewise, urological entities such as nephrolithiasis and neurogenic bladder alas presented in the same proportion. Almost half (40%) had all 5 risk factors, 1 participant had 4, 1 had 2, and 1 was only older than 50 years. 

The study later compared these results with the pattern associated with rheumatoid arthritis (RA) treated with tocilizumab. Urosepsis only occurred in 24.2% of the cases. The risk factors were similar, with 92% of the patients having at least 1 of them. Importantly, while urosepsis presented 75 days after treatment initiation in NMOSD, in those with RA, it occurred only in 10 days. 

These findings highlight the importance of identifying certain characteristics and patterns of patients receiving treatments with a high risk of developing sepsis and subsequently tailoring their management. 

“We therefore recommended performing regular urine tests and, when necessary, urine culture tests for NMOSD patients being administered satralizumab, especially for those with the above-mentioned RFs,” the authors concluded. 


Fujita R, Aratake Y, Nakata K, Fujii C, Komodo T. Urosepsis risk  in neuromyelitis optica spectrum disorder patients administered satralizumab. Intern Med Advanced Publication. Published online April 7, 2023. doi:10.2169/internalmedicine.1642-23