Efficacy and safety of rituximab in autoimmune encephalitis: A meta-analysis.

Autor: Nepal G; Maharajgunj Medical Campus, Tribhuvan University Institute of Medicine, Kathmandu, Nepal., Shing YK; Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore., Yadav JK; Maharajgunj Medical Campus, Tribhuvan University Institute of Medicine, Kathmandu, Nepal., Rehrig JH; University of New England College of Osteopathic Medicine, Biddeford, ME, USA., Ojha R; Department of Neurology, Maharajgunj Medical Campus, Tribhuvan University Institute of Medicine, Kathmandu, Nepal., Huang DY; Department of Neurology, Shanghai East Hospital of Tongji University School of Medicine, Shanghai, China., Gajurel BP; Department of Neurology, Maharajgunj Medical Campus, Tribhuvan University Institute of Medicine, Kathmandu, Nepal.
Jazyk: angličtina
Zdroj: Acta neurologica Scandinavica [Acta Neurol Scand] 2020 Nov; Vol. 142 (5), pp. 449-459. Date of Electronic Publication: 2020 Jun 16.
DOI: 10.1111/ane.13291
Abstrakt: 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.
(© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)
Databáze: MEDLINE
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