視神経炎症状を有する抗 AQP4抗体陽性視神経脊髄炎に対しサトラリズマブを投与した4例の検討

In the long-term treatment of anti-aquaporin-4 antibody-positive neuromyelitis optica spectrum disorder (AQP4NMOSD) patients, suppression of recurrence and reduction of the adverse effects of immunosuppressive drugs are serious issues. Although the use of targeted molecular therapy can lead to reduction of the dose of concomitant immunosuppressants, satralizumab, the use of which was approved for patients with AQP4NMOSD in 2020 by the Ministry of Health, Labor and Welfare in Japan, has been reported to be used in only few clinical cases. In this study, we report the ophthalmological examination of four cases where satralizumab was used as long-term therapy, at the General South Tohoku Hospital. The observation period was from August 1, 2021 to August 1, 2023, and the visual acuity, field of vision, absence of recurrence, and immunosuppressive drug dose were examined in four cases. During the observation period, all the patients discontinued treatment with steroid-containing immunosuppressant regimens and switched to satralizumab monotherapy. None of the patients had flare-ups of AQP4NMOSD, and none had worsening of visual acuity or visual field, or any other serious adverse reactions. In this study, satralizumab contributed to the discontinuation of immunosuppressive drugs and there was no recurrence of AQP4NMOSD. However, our case series demonstrating the efficacy and safety of satralizumab monotherapy is small, and long-term effects could not be assessed in this study. Larger case studies to verify the long-term efficacy and safety of single-agent treatments are recommended.