Maharajgunj Medical Campus, Tribhuvan University Institute of Medicine, Kathmandu, Nepal.
Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Acta Neurol Scand. 2020 Nov;142(5):449-459. doi: 10.1111/ane.13291. Epub 2020 Jun 16.
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.
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.
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.
Our meta-analysis showed that rituximab is an effective second-line agent for AE with an acceptable toxicity profile.
自身免疫性脑炎（AE）是一种罕见但使人虚弱的神经疾病，其特征是机体产生针对神经元细胞表面/突触蛋白的抗体。利妥昔单抗是一种抗 CD20 嵌合单克隆抗体，在 AE 治疗观察性研究中显示出良好的疗效。据我们所知，以前没有荟萃分析提供关于利妥昔单抗作为二线治疗 AE 的有效性和安全性的可靠证据。
本研究按照 PRISMA（系统评价和荟萃分析的首选报告项目）声明进行。研究人员独立检索了 PubMed、Web of Science、Google Scholar、WANFANG、CNKI 和 J-STAGE 以查找研究。通过有代表性的森林图进行荟萃分析，以评估良好的功能结局（mRS≤2）、复发比例以及治疗前后 mRS 评分变化。
利妥昔单抗治疗后末次随访时，72.2%（95% CI：66.3%-77.4%）的患者获得了良好的功能结局。mRS 评分平均降低了 2.67（95% CI：2.04-3.3；P<0.001）。利妥昔单抗治疗后仅 14.2%（95% CI：9.5%-20.8%）的患者出现复发。29 例（15.7%）、11 例（6.0%）和 2 例（1.1%）患者分别出现输注相关反应、肺炎和严重脓毒症。
我们的荟萃分析表明，利妥昔单抗是治疗 AE 的有效二线药物，具有可接受的毒性特征。
