抗 N-甲基-D-天冬氨酸受体脑炎患者静脉注射免疫球蛋白与静脉注射甲基强的松龙治疗的疗效和耐受性。

Efficacy and tolerability of intravenous immunoglobulin versus intravenous methylprednisolone treatment in anti-N-methyl-d-aspartate receptor encephalitis.

机构信息

Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.

Institute of Brain Science and Brain-Inspired Technology of West China Hospital, Sichuan University, Chengdu, China.

出版信息

Eur J Neurol. 2022 Apr;29(4):1117-1127. doi: 10.1111/ene.15214. Epub 2022 Jan 9.

DOI:10.1111/ene.15214

PMID:34918418

Abstract

BACKGROUND AND PURPOSE

The aim was to compare the effectiveness and safety of intravenous immunoglobulin (IVIg) or intravenous methylprednisolone (IVMP) versus IVIg plus IVMP (IPI) as initial therapy in anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis.

METHODS

This was a multicenter study of prospectively identified NMDAR encephalitis individuals who presented from October 2011 to August 2020 to the study hospitals of western China, with a median follow-up of 3.9 years. Prespecified candidate variables were the prescriptions of IVIg, IVMP or IPI. Propensity score matching was also performed to control potential confounders.

RESULTS

A total of 347 NMDAR encephalitis patients were finally analyzed in this study. After TriMatch for NMDAR encephalitis, 37 triplets were generated. Compared to IVIg or IVMP, the administration of IPI exhibited a significant benefit of a higher response rate (86.5% vs. 55.6% vs. 68.7%, p < 0.01), improved modified Rankin Scale score at 3, 6 and 12 months (p < 0.05), and reduced further recurrence rate (10 of 37 [27.0%] vs. 9 of 37 [24.3%] vs. 2 of 37 [5.4%]; p log rank = 0.01). There was no association between treatment superiority and patient sex or the presence of tumors (p ≥ 0.05). Patients treated with IVMP had a significantly higher number of adverse events, but 99% of adverse events were mild to moderate and did not lead to a change in treatment.

CONCLUSION

In patients with NMDAR encephalitis, adequate response, favorable outcome and less recurrence were each more likely to occur in individuals treated with a combined immunotherapy than in monotherapy individuals.

摘要

背景与目的

本研究旨在比较静脉注射免疫球蛋白（IVIg）或静脉注射甲基强的松龙（IVMP）与 IVIg 联合 IVMP（IPI）作为抗 N-甲基-D-天冬氨酸受体（NMDAR）脑炎初始治疗的疗效和安全性。

方法

这是一项多中心研究，纳入 2011 年 10 月至 2020 年 8 月期间来自中国西部研究医院的前瞻性确诊的 NMDAR 脑炎患者，中位随访时间为 3.9 年。预设的候选变量为 IVIg、IVMP 或 IPI 的处方。还进行了倾向性评分匹配以控制潜在混杂因素。

结果

本研究最终分析了 347 例 NMDAR 脑炎患者。经过 NMDAR 脑炎的 TriMatch 后，生成了 37 对。与 IVIg 或 IVMP 相比，IPI 的给药具有更高的反应率（86.5%比 55.6%比 68.7%，p<0.01）、3、6 和 12 个月时改良 Rankin 量表评分的改善（p<0.05）以及降低进一步复发率（37 例中有 10 例[27.0%]比 37 例中有 9 例[24.3%]比 37 例中有 2 例[5.4%]；对数秩检验 p=0.01）的优势。治疗优势与患者性别或肿瘤存在无关（p≥0.05）。接受 IVMP 治疗的患者发生不良事件的数量明显更高，但 99%的不良事件为轻度至中度，且未导致治疗改变。