Objective:

Background:

NMOSD is a relapsing autoimmune disorder of the central nervous system, often accompanied by neuropathic pain due to spinal cord lesions. Long-term GC and immunosuppressant therapy often results in polypharmacy. Satralizumab, an interleukin-6 (IL-6) receptor inhibitor, effectively prevents relapses in NMOSD; however, its real-world effects on pain management and polypharmacy remain to be fully elucidated.

Design/Methods:

We retrospectively analyzed 23 patients (21 women, 91%) with AQP4-IgG–positive NMOSD treated at a single center between 2014 and 2025. Satralizumab (120 mg) was administered subcutaneously at weeks 0, 2, and 4, then every 4 weeks. Pre- and post-initiation comparisons included numerical rating scale (NRS) pain scores (0–10), numbers and types of concomitant medications, and daily GC dose.

Results:

The mean age at initiation was 54 years, with a median follow-up of 2.3 years. One patient experienced a relapse. At baseline, 86% reported pain; among those continuing treatment, the median NRS improved from 7 to 4 (p < 0.001), and over 50% reported subjective pain relief. The mean daily prednisolone dose decreased from 10 mg to 4 mg (p < 0.001), with most patients tapering GCs without relapse. The mean number of medications decreased from 12 to 10 (p < 0.05); 59% initially used ≥10 drugs. At initiation, 96% were receiving oral prednisolone; other frequently used drugs included antacids (96%), osteoporosis agents (86%), and analgesics (65%).

Conclusions:

In routine clinical practice, satralizumab is associated with improved pain, reduced medication use, and successful GC tapering while maintaining relapse control. These findings suggest that IL-6 receptor inhibition may not only prevent relapses but also mitigate polypharmacy and improve quality of life in patients with NMOSD.