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Simplified regimen of combined low-dose rituximab for autoimmune encephalitis with neuronal surface antibodies

التفاصيل البيبلوغرافية
العنوان: Simplified regimen of combined low-dose rituximab for autoimmune encephalitis with neuronal surface antibodies
المؤلفون: Ying Du, Chao Zhao, Juntong Liu, Chuan Li, Qi Yan, Lin Li, Yunfeng Hao, Dan Yao, Huaxing Si, Yingjun Zhao, Wei Zhang
المصدر: Journal of Neuroinflammation, Vol 19, Iss 1, Pp 1-15 (2022)
بيانات النشر: BMC, 2022.
سنة النشر: 2022
المجموعة: LCC:Neurology. Diseases of the nervous system
مصطلحات موضوعية: Autoimmune encephalitis, Neuronal surface antibody, Rituximab, Low dose, Combined treatment, Clinical outcome, Neurology. Diseases of the nervous system, RC346-429
الوصف: Abstract Background Autoimmune encephalitis (AE) with neuronal surface antibodies (NSAbs) presents pathogenesis mediated by B cell-secreting antibodies. Rituximab is a second-line choice for the treatment for AE with NSAbs, which can cause B cell depletion via targeting CD20. However, the optimal protocol and dosage of rituximab combined with first-line therapy for NSAbs-associated AE remains unclear so far. In this study, we explored the efficacy and safety of low-dose rituximab combined with first-line treatment for NSAbs-associated AE. Methods Fifty-nine AE patients with NSAbs were enrolled, and retrospectively divided into common first-line therapy (41 patients) and combined low-dose rituximab (100 mg induction weekly with 3 circles, followed by 100 mg reinfusion every 6 months) with first-line therapy (18 patients). Outcome measures included changes in the Clinical Assessment Scale for Autoimmune Encephalitis (CASE) score (primary endpoint), changes in the modified Rankin Scale (mRS), the Mini-mental State Examination (MMSE), the patient and caregiver Neuropsychiatric Inventory (NPI) score at each visit (baseline, discharge, 6 months, 12 months and last follow-up) between two groups (secondary endpoint), as well as oral prednisone dosage, relapse and adverse effects during follow-up. Results Compared with traditional first-line therapy group, for primary outcome, CASE scores at last follow-up were significantly improved in combined rituximab group, as well as markedly improving changes of CASE scores between baseline and each visit. While changes of mRS, MMSE and NPI scores, as secondary endpoint, were all markedly accelerating improvement between baseline and each visit, as well as both oral prednisone dosage and relapse were also greatly reduced during follow-up. Meanwhile, longitudinal analysis in combination of rituximab cohort also revealed persistently marked amelioration in a series of scales from baseline even more than 1 year. Moreover, analysis in rituximab subgroup showed no difference in any clinical outcomes between combination with single first-line and with repeated first-line treatment (≥ 2 times), while compared to delayed combination with rituximab (> 3 months), early initiation of combination (≤ 3 months) might achieve better improvements in CASE and MMSE assessment even 1 year later. No rituximab-correlated serious adverse events have been reported in our patients. Conclusions Our simplified regimen of combined low-dose rituximab firstly showed significantly accelerating short-term recovery and long-term improvement for AE with NSAbs, in parallel with markedly reduced prednisone dosage and clinical relapses. Moreover, opportunity of protocol showed earlier initiation (≤ 3 months) with better long-term improvement.
نوع الوثيقة: article
وصف الملف: electronic resource
اللغة: English
تدمد: 1742-2094
96929065
Relation: https://doaj.org/toc/1742-2094
DOI: 10.1186/s12974-022-02622-8
URL الوصول: https://doaj.org/article/fbda9692906549e1a9c3e9939e8f4883
رقم الأكسشن: edsdoj.fbda9692906549e1a9c3e9939e8f4883
قاعدة البيانات: Directory of Open Access Journals
الوصف
تدمد:17422094
96929065
DOI:10.1186/s12974-022-02622-8