Cases of <scp>AQP4</scp> ‐Antibody‐Positive Neuromyelitis Optica Spectrum Disorder Successfully Discontinuing Steroids With Satralizumab Treatment: Considerations on the Method of Tapering for Steroids After the Introduction of Satralizumab

ABSTRACT Background Satralizumab is used for the treatment of neuromyelitis optica spectrum disorder (NMOSD). However, there are currently no standardized guidelines regarding the method or speed of steroid tapering after its introduction. In 2023, we proposed a method to commence tapering prednisolone at a rate of 1 mg every 4 weeks, starting 8 weeks after satralizumab introduction (following four subcutaneous administrations of 120 mg each). Here we report the clinical courses of four patients with aquaporin‐4 antibody (AQP4)‐positive NMOSD who discontinued steroids following a similar tapering method, advocating for the utility of this approach. Case Presentation Case 1 (67‐year‐old female) and Case 2 (66‐year‐old female) exhibited optic nerve and spinal cord lesions. Case 3 (43‐year‐old female) involved lesions extending from the medulla to the spinal cord, whereas Case 4 (68‐year‐old female) exhibited only optic neuritis. All patients were diagnosed with AQP4‐antibody‐positive NMOSD based on the 2015 International Diagnostic Criteria. The initial prednisolone doses before reduction in Cases 1–4 were 25, 25, 10, and 7 mg/day, respectively. The durations from steroid discontinuation to September 11, 2025, for Cases 1–4 were 248, 1178, 1120, and 838 days, respectively, with no relapses observed to date. Conclusions Initiating prednisolone tapering at a rate of 1 mg every 4 weeks starting 8 weeks after satralizumab introduction appears to be an effective and safe approach.