Satralizumab

How it works

It blocks the IL-6 receptor, interrupting IL-6-mediated inflammatory signalling that contributes to the immunopathology of NMOSD.

Prescribing in practice

• By suppressing IL-6 signalling it increases the risk of serious infection and can blunt the usual signs such as fever and acute-phase response, so infections may present atypically and require careful vigilance.
• Hepatic transaminases and neutrophil counts can fall, so liver function and blood counts are checked before and during treatment.
• Screening for tuberculosis and hepatitis B and review of vaccination status are needed before initiation, with live vaccines avoided during treatment.

Monitoring

Monitor neutrophil count, liver transaminases and clinical signs of infection during therapy, bearing in mind that IL-6 blockade may mask inflammatory markers.

Counselling the patient

• Report any signs of infection promptly, as the usual warning signs such as fever may be reduced.
• Attend for the blood tests arranged to check your liver and white cell counts.
• Discuss any planned vaccinations with your specialist team beforehand.

Evidence & guidelines

Satralizumab reduced relapse rates in aquaporin-4 antibody-positive NMOSD in the randomised SAkuraStar and SAkuraSky trials and is recommended by NICE for eligible patients.