Gaurav Nepal1, Yow K Shing2, Jayant K Yadav1, Jessica H Rehrig3, Rajeev Ojha4, Dong Y Huang5, Bikram P Gajurel4. 1. Maharajgunj Medical Campus, Tribhuvan University Institute of Medicine, Kathmandu, Nepal. 2. Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. 3. University of New England College of Osteopathic Medicine, Biddeford, ME, USA. 4. Department of Neurology, Maharajgunj Medical Campus, Tribhuvan University Institute of Medicine, Kathmandu, Nepal. 5. Department of Neurology, Shanghai East Hospital of Tongji University School of Medicine, Shanghai, China.
Abstract
BACKGROUND: Autoimmune encephalitis (AE) is a rare but debilitating neurological disease where the body develops antibodies against neuronal cell surface/synaptic proteins. Rituximab is an anti-CD20 chimeric monoclonal antibody which shows promise in AE treatment observational studies. To our knowledge, there has been no previous meta-analysis providing robust evidence on the effectiveness and safety of rituximab as second-line therapy for the treatment for AE. METHODS: This study was conducted according to the PRISMA (Preferred Reporting Items for Systematic review and Meta-Analysis) statement. Investigators independently searched PubMed, Web of Science, Google Scholar, WANFANG, CNKI, and J-STAGE for studies. Meta-analysis via representative forest plots was conducted for good functional outcome (mRS ≤ 2), proportion of relapse, and mRS score change pre- and post-treatment. RESULTS: Good functional outcome at last follow-up following rituximab therapy occurred in 72.2% of patients (95% CI: 66.3%-77.4%). Mean mRS score decreased by 2.67 (95% CI: 2.04-3.3; P < .001). Relapses following the rituximab therapy occurred in only 14.2% of patients (95% CI: 9.5%-20.8%). Infusion related reactions, pneumonia, and severe sepsis were seen in 29 (15.7%), 11 (6.0%), and two patients (1.1%), respectively. The efficacy and side effect profile of rituximab are comparable to outcomes seen in rituximab use in other autoimmune and inflammatory CNS disease. CONCLUSION: Our meta-analysis showed that rituximab is an effective second-line agent for AE with an acceptable toxicity profile.
BACKGROUND:Autoimmune encephalitis (AE) is a rare but debilitating neurological disease where the body develops antibodies against neuronal cell surface/synaptic proteins. Rituximab is an anti-CD20 chimeric monoclonal antibody which shows promise in AE treatment observational studies. To our knowledge, there has been no previous meta-analysis providing robust evidence on the effectiveness and safety of rituximab as second-line therapy for the treatment for AE. METHODS: This study was conducted according to the PRISMA (Preferred Reporting Items for Systematic review and Meta-Analysis) statement. Investigators independently searched PubMed, Web of Science, Google Scholar, WANFANG, CNKI, and J-STAGE for studies. Meta-analysis via representative forest plots was conducted for good functional outcome (mRS ≤ 2), proportion of relapse, and mRS score change pre- and post-treatment. RESULTS: Good functional outcome at last follow-up following rituximab therapy occurred in 72.2% of patients (95% CI: 66.3%-77.4%). Mean mRS score decreased by 2.67 (95% CI: 2.04-3.3; P < .001). Relapses following the rituximab therapy occurred in only 14.2% of patients (95% CI: 9.5%-20.8%). Infusion related reactions, pneumonia, and severe sepsis were seen in 29 (15.7%), 11 (6.0%), and two patients (1.1%), respectively. The efficacy and side effect profile of rituximab are comparable to outcomes seen in rituximab use in other autoimmune and inflammatory CNS disease. CONCLUSION: Our meta-analysis showed that rituximab is an effective second-line agent for AE with an acceptable toxicity profile.
Authors: Franziska S Thaler; Luise Zimmermann; Stefan Kammermeier; Christine Strippel; Marius Ringelstein; Andrea Kraft; Kurt-Wolfram Sühs; Jonathan Wickel; Christian Geis; Robert Markewitz; Christian Urbanek; Claudia Sommer; Kathrin Doppler; Loana Penner; Jan Lewerenz; Rosa Rößling; Carsten Finke; Harald Prüss; Nico Melzer; Klaus-Peter Wandinger; Frank Leypoldt; Tania Kümpfel Journal: Neurol Neuroimmunol Neuroinflamm Date: 2021-10-01