Intitiation of satralizumab during pregnancy for successful childbirth in neuromyelitis optica spectrum disorder: A case report and literature review.

Neuromyelitis optica spectrum disorder (NMOSD) predominantly affects women of reproductive age, posing significant risks for pregnancy-associated relapses and adverse perinatal outcomes. While biologic agents such as satralizumab are established therapies for NMOSD, data regarding their safety and efficacy when initiated during pregnancy remain scarce. Here we report the case of a 32-year-old woman with a history of NMOSD (diagnosed at age 24), taking oral low-dose prednisolone before conception. To mitigate the risk of relapse, satralizumab was first injected at 28 + 3 weeks of gestation. She delivered vaginally at 40 + 1 weeks of gestation without peripartum complications or disease relapse. Notably, while transplacental transfer of satralizumab was demonstrated, the drug was undetectable in breast milk and the neonate developed normally. To our knowledge, this is the first reported case of satralizumab initiation during pregnancy for relapse prevention in a patient with NMOSD. Our findings suggest that satralizumab may represent a viable therapeutic option for NMOSD management even when pregnancy is already established.