Satralizumab in the management of aquaporin-4 antibody-positive neuromyelitis optica spectrum disorder during pregnancy: a case report

By
Man Ding
Bo Yin
Jiajia Yao
Yin Liu
Hongjuan Dong
Zuneng Lu
May 21, 2026

Frontiers In Immunology

Overview

This case study highlights the successful management of a pregnant woman with aquaporin-4 antibody-positive neuromyelitis optica spectrum disorder (NMOSD) using satralizumab. The treatment led to significant clinical improvement and favorable maternal-neonatal outcomes, marking an important contribution to the understanding of NMOSD management during pregnancy.

Background

Neuromyelitis optica spectrum disorder (NMOSD) is a severe autoimmune condition that can complicate pregnancy due to increased relapse risks. Traditional immunosuppressive therapies pose teratogenic risks, necessitating safer alternatives. Satralizumab, a monoclonal antibody with low placental transfer, presents a promising option for managing NMOSD in pregnant patients, although real-world evidence is limited.

Data Highlights

No numerical data or trial data provided in the article.

Key Findings

The patient was diagnosed with AQP4+ NMOSD at 19 weeks of gestation.
High-dose prednisone pulse therapy was initiated during the acute phase of the disease.
Satralizumab was introduced as an adjunctive therapy four weeks after disease onset.
Marked improvement in visual field defect and successful spontaneous delivery were observed.
Transient early neonatal complications occurred, but the infant showed favorable short-term recovery.

Clinical Implications

This case underscores the potential of satralizumab as a safe treatment option for NMOSD during pregnancy, allowing for effective management while minimizing risks to the fetus. Clinicians should consider this therapy in similar cases, balancing the need for disease control with the safety of both mother and child.

Conclusion

The successful management of NMOSD with satralizumab during pregnancy provides valuable insights for clinicians. Further studies are needed to establish comprehensive guidelines for treating NMOSD in pregnant patients.