Objective:

To fill the evidence gap regarding the use of inebilizumab in pregnant patients with neuromyelitis optica spectrum disorder (NMOSD) and provide detailed data on its application as well as the long-term outcomes for mothers, fetuses, and the disease.

Background:

NMOSD is an autoimmune disease characterized by inflammatory demyelinating lesions affecting the optic nerve and spinal cord. As a rare condition, its clinical management—particularly in special populations such as pregnant patients—remains challenging. Inebilizumab, a B-cell-depleting biological agent in NMOSD treatment, has demonstrated efficacy in disease control. However, no prior clinical reports have described its use in pregnant patients or the associated long-term maternal, fetal, and disease outcomes, leaving a critical gap. 

Design/Methods:

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Results:

We report a female patient with anti-AQP4antibody-positive NMOSD who experienced an unplanned pregnancy during three cycles of inebilizumab maintenance therapy. A multidisciplinary team (neurologists, obstetricians, and immunologists) collaborated to develop an individualized treatment plan. Following confirmation of pregnancy, her therapy was adjusted to low-dose methylprednisolone combined with azathioprine. During pregnancy, monitoring revealed persistently low B-cell counts, with low anti-AQP4 antibody titers in the second trimester. A successful cesarean section was performed at 38 weeks and 5 days, resulting in a safe delivery for both mother and baby. On the 11th day postpartum, she received 300 mg of inebilizumab treatment. There were no relapses or infections during the entire pregnancy and three months postpartum.

Conclusions: