Wang Bao-Jie, Wang Chun-Juan, Zeng Zi-Ling, Yang Yang, Guo Shou-Gang
Department of Neurology, Shandong Provincial Hospital affiliated to Shandong University, Jing Wu Road, Huaiyin District, Jinan 250021, Shandong, China.
Department of Neurology, Shandong Provincial Hospital affiliated to Shandong University, Jing Wu Road, Huaiyin District, Jinan 250021, Shandong, China.
J Neurol Sci. 2017 Jun 15;377:127-132. doi: 10.1016/j.jns.2017.04.007. Epub 2017 Apr 8.
The aim of this study was to evaluate the use and efficacy of lower dosages of rituximab for treating anti N-methyl-d-aspartate receptor (NMDAR) encephalitis without tumour.
We performed a prospective study of 10 patients with anti-NMDAR encephalitis who did not respond to 10 to 14days first-line immunotherapy and received rituximab administered intravenously (IV) at a dosage of 100mg once per week for 4 consecutive weeks. Reinfusion of rituximab was given when CD19 B-cell counts of total lymphocytes in peripheral blood >1%. The annualized relapse rate (ARR), modified Rankin scale (mRS) and CD19 B-cell counts were measured every 4 to 10weeks after initial rituximab treatment in order to assess the clinical outcome and efficacy of rituximab.
Lower dosages of rituximab led to a significant reduction of mRS and CD19 B-cells when compared with before the rituximab infusion (P<0.05) and allowed 9 (90%) patients to maintain a stabilised neurological status. One patient experienced a relapse at 19weeks after initial rituximab infusion. Although ARR reduction of all 10 patients did not achieve statistical significance (P>0.05), in the 4 patients who had relapses before rituximab treatment there was an apparent reduction in ARR over 56weeks. At the last follow up, 9 patients (90%) had a good outcome (mRS≤2) including 3 patients (30%) who recovered completely (mRS=0). Transient infusion adverse events occurred in 2 patients. We observed no serious delayed adverse events during the 56weeks follow-up.
In patients with anti-NMDAR encephalitis who did not respond to first-line immunotherapy, early application of lower dosages of rituximab could efficiently reduce CD19 B-cell counts of peripheral blood and improve the prognosis of anti-NMDAR encephalitis.
本研究旨在评估较低剂量利妥昔单抗用于治疗无肿瘤的抗N-甲基-D-天冬氨酸受体（NMDAR）脑炎的使用情况及疗效。
我们对10例抗NMDAR脑炎患者进行了一项前瞻性研究，这些患者对10至14天的一线免疫治疗无反应，并接受静脉注射（IV）利妥昔单抗，剂量为每周100mg，连续4周。当外周血总淋巴细胞中CD19 B细胞计数>1%时，进行利妥昔单抗再输注。在初始利妥昔单抗治疗后每4至10周测量年化复发率（ARR）、改良Rankin量表（mRS）和CD19 B细胞计数，以评估利妥昔单抗的临床结局和疗效。
与利妥昔单抗输注前相比，较低剂量的利妥昔单抗导致mRS和CD19 B细胞显著减少（P<0.05），并使9例（90%）患者维持稳定的神经状态。1例患者在初始利妥昔单抗输注后19周复发。尽管所有10例患者的ARR降低未达到统计学意义（P>0.05），但在利妥昔单抗治疗前复发的4例患者中，56周内ARR明显降低。在最后一次随访时，9例（90%）患者预后良好（mRS≤2），其中3例（30%）完全康复（mRS=0）。2例患者发生短暂的输注不良事件。在56周的随访期间，我们未观察到严重的延迟不良事件。
在对抗NMDAR脑炎一线免疫治疗无反应的患者中，早期应用较低剂量的利妥昔单抗可有效降低外周血CD19 B细胞计数，并改善抗NMDAR脑炎的预后。
