Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Epilepsia. 2024 Nov;65(11):3199-3215. doi: 10.1111/epi.18107. Epub 2024 Sep 26.
In adult anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis, corticosteroids are commonly used as first-line treatment. However, the optimal oral prednisone tapering (OPT) following intravenous methylprednisolone pulse therapy remains unclear. We aim to compare the efficacy and safety of different OPT courses in anti-NMDAR encephalitis.
The CHASE study, a multicenter prospective observational cohort study, enrolled patients with autoimmune encephalitis from October 2011 to March 2023. Patients were grouped based on oral prednisone tapering course: ≤3 months (Group ≤3 month), 3-6 months (Group 3-6 months, including 3 months), and >6 months (Group > 6 months). Kaplan-Meier plots were used to analyze time to relapse and time to total recovery within 2 years.
Among 666 screened patients, 171 (median [IQR] age 27 [21.0-36.5] years, 55.0% female) met selection criteria. Responders at 3 months were prevalent in Group ≤3 months (OR 7.251 [95% CI 2.252 to 23.344] and Group 3-6 months (OR, 3.857 [95% CI 1.107 to 13.440] than in Group >6 months. Clinical Assessment Scale for Autoimmune Encephalitis (CASE) scores at 12 months were higher in Group >6 months than in Group ≤3 months and Group 3-6 months (β, -2.329 [95% CI -3.784 to -.875]; β, -2.871 [95% CI -4.490, -1.253]). CASE seizures subscore was higher in Group >6 months than in Group 3-6 months (β, -.452 [95% CI -.788 to -.116]). No significant difference in seizure freedom rates among the groups. Adverse events were higher in Group 3-6 months and Group >6 months than in Group ≤3 months (OR 6.045 [95% CI 2.352 to 15.538]; OR 6.782 [95% CI 1.911 to 24.073]).
Longer oral prednisone courses for adult patients with anti-NMDAR encephalitis did not show superior effects compared to shorter courses in improving modified Rankin Scale (mRS) scores and CASE scores, reducing the risk of relapse within 2 years, or achieving seizure freedom. Instead, extended prednisone courses may lead to more side effects- particularly weight gain. This outcome recommends evaluating the possibility of shortening the duration of oral prednisone after a thorough patient assessment.
在成人抗 N-甲基-D-天冬氨酸受体（NMDAR）脑炎中，常采用皮质类固醇作为一线治疗。然而，静脉注射甲基强的松龙脉冲治疗后，最佳的口服泼尼松减量（OPT）方案仍不清楚。我们旨在比较抗 NMDAR 脑炎不同 OPT 方案的疗效和安全性。
CHASE 研究是一项多中心前瞻性观察队列研究，纳入 2011 年 10 月至 2023 年 3 月期间自身免疫性脑炎患者。根据口服泼尼松减量方案将患者分为三组：≤3 个月（组 1：≤3 个月）、3-6 个月（组 2：3-6 个月，含 3 个月）和＞6 个月（组 3：＞6 个月）。采用 Kaplan-Meier 图分析 2 年内的复发时间和完全恢复时间。
在筛选出的 666 例患者中，171 例（中位[IQR]年龄 27 [21.0-36.5]岁，55.0%为女性）符合入选标准。与组 3：＞6 个月相比，组 1 和组 2 中 3 个月时应答者更为常见（OR 7.251[95%CI 2.252-23.344]和 OR 3.857[95%CI 1.107-13.440]）。12 个月时，组 3：＞6 个月的临床评估自身免疫性脑炎量表（CASE）评分高于组 1 和组 2（β，-2.329[95%CI -3.784，-0.875]；β，-2.871[95%CI -4.490，-1.253]）。组 3：＞6 个月的 CASE 癫痫发作亚评分高于组 2（β，-.452[95%CI -.788，-0.116]）。三组间癫痫无发作率无显著差异。与组 1 相比，组 2 和组 3 的不良事件发生率更高（OR 6.045[95%CI 2.352-15.538]；OR 6.782[95%CI 1.911-24.073]）。
对于成人抗 NMDAR 脑炎患者，较长的口服泼尼松疗程与较短疗程相比，在改善改良 Rankin 量表（mRS）评分和 CASE 评分、降低 2 年内复发风险或达到癫痫无发作方面并无优势。相反，延长泼尼松疗程可能会导致更多的副作用，特别是体重增加。这一结果提示，在充分评估患者后，可考虑缩短口服泼尼松的疗程。
