硼替佐米用于治疗达利珠单抗治疗后的多发性硬化症患者的抗NMDAR脑炎。
Bortezomib for anti-NMDAR encephalitis following daclizumab treatment in a patient with multiple sclerosis.
作者信息
Karunaratne Kushan, Ahrabian Dariush, Monoghan Bernadette, Campion Tom, Yousry Tarek, Lunn Michael P, Zandi Michael S, Howard Robin S, Kullmann Dimitri M, Spillane Jennifer, Walker Matthew, Chataway Jeremy
机构信息
National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK.
Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, University College London Hospitals NHS Foundation Trust National Hospital for Neurology and Neurosurgery, London, UK.
出版信息
BMJ Neurol Open. 2021 May 18;3(1):e000096. doi: 10.1136/bmjno-2020-000096. eCollection 2021.
BACKGROUND
Daclizumab is an anti-CD25 monoclonal antibody developed for the treatment of relapsing remitting multiple sclerosis, which was withdrawn worldwide in March 2018, due to emerging serious immune-mediated systemic andcentral nervous system adverse events. We report a case of anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis occurring 14 weeks after stopping daclizumab, which responded to the proteasome inhibitor bortezomib.
METHODS
Following lack of effective clinical response to first line (corticosteroid, plasma exchange, intravenous immunoglobulin) and second line (rituximab) treatments, bortezomib therapy was commenced. The patient received six cycles of bortezomib treatment.
RESULTS
Clinical improvement was noted 4 weeks after the first of six cycles of bortezomib and the patient experienced sustained clinical improvement.
CONCLUSION
Our case provides further class IV evidence of the use of bortezomib therapy for treatment refractory anti-NMDAR encephalitis.
背景
达克珠单抗是一种开发用于治疗复发缓解型多发性硬化症的抗CD25单克隆抗体，由于出现严重的免疫介导的全身性和中枢神经系统不良事件，于2018年3月在全球范围内撤市。我们报告1例在停用达克珠单抗14周后发生的抗N-甲基-D-天冬氨酸受体（NMDAR）脑炎病例，该病例对蛋白酶体抑制剂硼替佐米有反应。
方法
在对一线治疗（皮质类固醇、血浆置换、静脉注射免疫球蛋白）和二线治疗（利妥昔单抗）缺乏有效的临床反应后，开始硼替佐米治疗。患者接受了6个周期的硼替佐米治疗。
结果
在6个周期的硼替佐米治疗的第1个周期后4周观察到临床改善，且患者经历了持续的临床改善。
结论
我们的病例为硼替佐米治疗难治性抗NMDAR脑炎的应用提供了进一步的IV级证据。
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