1. Rituximab Treatment and Long-term Outcome of Patients With Autoimmune Encephalitis
- Author
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Thaler, Franziska S, Zimmermann, Luise, Urbanek, Christian, Pfefferkorn, Thomas, Philipsen, Alexandra, Piepgras, Johannes, von Podewils, Felix, Priller, Josef, Pröbstel, Anne-Katrin, Helena Rau, Johanna Maria, Räuber, Saskia Jania, Reimann, Gernot, Reinecke, Raphael, Sommer, Claudia, Ringelstein, Marius, Rohner, Hendrik, Rosenow, Felix, Rostásy, Kevin, Rüegg, Stephan, Schaumberg, Jens, Schmidt, Jens, Schmütz, Ina-Isabelle, Schreiber, Stephan, Schreyer, Gesa, Doppler, Kathrin, Schröder, Ina, Schuster, Simon, Seidel, Günter, Senel, Makbule, Siebenbrodt, Kai, Stammel, Oliver, Stangel, Martin, Stolze, Henning, Stoppe, Muriel, Storm Van's Gravesande, Karin, Penner, Loana, Sybre, Steffen, Tauber, Simone, Bergh, Florian Then, Trebst, Corinna, Trendelenburg, George, Trollmann, Regina, Tumani, Hayrettin, Türedi, Methab, von Mering, Matthias, Wagner, Judith, Lewerenz, Jan, Weissert, Robert, Wiendl, Heinz, Wildemann, Brigitte, Witt, Karsten, Wöpking, Sigrid, Wunderlich, Benjamin, Zieger, Lara, Roessling, Rosa, Finke, Carsten, Prüß, Harald, Melzer, Nico, Wandinger, Klaus-Peter, Kammermeier, Stefan, Leypoldt, Frank, Kümpfel, Tania, Encephalitis, German Network for Research on Autoimmune, Adelmann, Michael, Appeltshauser, Luise, Ayzenberg, Ilya, Baade-Büttner, Carolin, van Baalen, Andreas, Baatz, Sebastian, Balint, Bettina, Strippel, Christine, Bauer, Sebastian, Baumgartner, Annette, Benesch, Sonka, Berger, Robert, Berning, Sascha, Bernsen, Sarah, Bien, Christian, Bien, Corinna, Binder, Andreas, Bittner, Stefan, Bittner, Daniel, Blaes, Franz, Blaschek, Astrid, Dargvainiene, Justina, Dik, Andre, Dreesmann, Mona, Ebinger, Friedrich, Edelhoff, Lena, Ehrlich, Sven, Eisenhut, Katharina, Kraft, Andrea, Endres, Dominique, Entscheva, Marina, Faiss, Jürgen Hartmut, Fazeli, Walid Ahmad, Finke, Alexander, Fitzner, Dirk, Flotats-Bastardas, Marina, Paul, Friedemann, Friese, Manuel, Gallus, Marco, Sühs, Kurt-Wolfram, Gebhard, Marcel, Geis, Christian, Gorsler, Anna, Grau, Armin, Grauer, Oliver, Groß, Catharina, Gül, Halime, Handreka, Robert, Hansen, Niels, Häusler, Martin, Wickel, Jonathan, Havla, Joachim, Ha-Yeun, Chung, Heide, Wolfgang, Held, Valentin, Hellwig, Kerstin, Hillebrand, Philip, Hoffmann, Frank, Oy, Ulrich Hofstadt-van, Ismail, Fatme Seval, Jansen, Martina, Kaufmann, Max, Kellinghaus, Christoph, Knake, Susanne, Körtvelyessy, Peter, Kovac, Stjepana, Krämer, Markus, Krogias, Christos, Lehrich, Christoph, Linsa, Andreas, Lünemann, Jan, Markewitz, Robert, Malter, Michael, Melzer, Kristin Stefanie, Menge, Til, Meuth, Sven, Meyer Zu Hörste, Gerd, Mönig, Constanze, Mono, Marie-Luise, Nagel, Michael, Neumann-Haefelin, Tobias, and Obrocki, Jost
- Subjects
Adult ,Male ,medicine.medical_specialty ,immunology [Anti-N-Methyl-D-Aspartate Receptor Encephalitis] ,anti-GAD65 autoantibody ,Disease ,Real world evidence ,Gastroenterology ,immunology [Autoimmune Diseases of the Nervous System] ,pharmacology [Immunosuppressive Agents] ,anti-CASPR2 autoantibody ,administration & dosage [Rituximab] ,Modified Rankin Scale ,Internal medicine ,Outcome Assessment, Health Care ,immunology [Autoantibodies] ,Humans ,Medicine ,In patient ,ddc:610 ,Registries ,immunology [Encephalitis] ,anti-NMDA receptor autoantibody ,Aged ,Autoantibodies ,Autoimmune encephalitis ,pharmacology [Rituximab] ,biology ,business.industry ,Middle Aged ,drug therapy [Encephalitis] ,Neurology ,Cohort ,administration & dosage [Immunosuppressive Agents] ,anti-leucine-rich glioma-inactivated 1 autoantibody ,biology.protein ,drug therapy [Autoimmune Diseases of the Nervous System] ,Female ,Rituximab ,Neurology (clinical) ,Antibody ,drug therapy [Anti-N-Methyl-D-Aspartate Receptor Encephalitis] ,business ,Immunosuppressive Agents ,Follow-Up Studies ,medicine.drug - Abstract
Background and ObjectivesTo determine the real-world use of rituximab in autoimmune encephalitis (AE) and to correlate rituximab treatment with the long-term outcome.MethodsPatients with NMDA receptor (NMDAR)-AE, leucine-rich glioma-inactivated-1 (LGI1)- AE, contactin-associated protein-like-2 (CASPR2)-AE, or glutamic acid decarboxylase 65 (GAD65) disease from the GErman Network for Research on AuToimmune Encephalitis who had received at least 1 rituximab dose and a control cohort of non–rituximab-treated patients were analyzed retrospectively.ResultsOf the 358 patients, 163 (46%) received rituximab (NMDAR-AE: 57%, CASPR2-AE: 44%, LGI1-AE: 43%, and GAD65 disease: 37%). Rituximab treatment was initiated significantly earlier in NMDAR- and LGI1-AE (median: 54 and 155 days from disease onset) compared with CASPR2-AE or GAD65 disease (median: 632 and 1,209 days). Modified Rankin Scale (mRS) scores improved significantly in patients with NMDAR-AE, both with and without rituximab treatment. Although being more severely affected at baseline, rituximab-treated patients with NMDAR-AE more frequently reached independent living (mRS score ≤2) (94% vs 88%). In LGI1-AE, rituximab-treated and nontreated patients improved, whereas in CASPR2-AE, only rituximab-treated patients improved significantly. No improvement was observed in patients with GAD65 disease. A significant reduction of the relapse rate was observed in rituximab-treated patients (5% vs 13%). Detection of NMDAR antibodies was significantly associated with mRS score improvement. A favorable outcome was also observed with early treatment initiation.DiscussionWe provide real-world data on immunosuppressive treatments with a focus on rituximab treatment for patients with AE in Germany. We suggest that early and short-term rituximab therapy might be an effective and safe treatment option in most patients with NMDAR-, LGI1-, and CASPR2-AE.Class of EvidenceThis study provides Class IV evidence that rituximab is an effective treatment for some types of AE.
- Published
- 2021
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