Department of Pediatric Neurology, Qilu Hospital of Shandong University, Jinan, Shandong, China.
Department of Pediatric Neurology, Qilu Hospital of Shandong University, Jinan, Shandong, China.
Pediatr Neurol. 2024 Dec;161:85-90. doi: 10.1016/j.pediatrneurol.2024.09.001. Epub 2024 Sep 6.
To evaluate the efficacy and safety of rituximab treatment for anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis without tumor in children.
Eighteen pediatric patients with NMDAR encephalitis treated with rituximab after failure of intravenous immunoglobulin (IVIG) and methylprednisolone treatment were analyzed retrospectively in terms of their medical history, clinical features, laboratory examination results, and treatments. The modified Rankin scale (mRS) score, peripheral blood CD19+ B cells, recurrence, and adverse events were used to evaluate the efficacy and safety of rituximab.
The patients were treated with rituximab 3.2 ± 1.0 days after the end of IVIG and methylprednisolone treatment. After initial rituximab treatment for four weeks, the mRS score and number of CD19+ B cells in all patients were significantly lower than those before treatment (P < 0.05). At the last follow-up (44.1 months, 17.7 S.D.), all patients had recovered well (mRS ≤2), 14 patients (77.8%) recovered completely (mRS = 0), three patients had recurrent seizures, and one patient had mental and language impairment. Two patients had transient mild adverse events during infusion, and none of the other patients experienced severe adverse events during hospitalization or follow-up.
Rituximab appears safe and may be effective for the treatment of anti-NMDAR encephalitis without tumor in children refractory to first-line agents.
评估利妥昔单抗治疗无肿瘤抗 N-甲基-D-天冬氨酸受体（NMDAR）脑炎在儿童中的疗效和安全性。
回顾性分析 18 例接受利妥昔单抗治疗的抗 NMDAR 脑炎患儿的病史、临床特征、实验室检查结果和治疗情况。采用改良 Rankin 量表（mRS）评分、外周血 CD19+B 细胞计数、复发和不良反应评估利妥昔单抗的疗效和安全性。
患儿在 IVIG 和甲基强的松龙治疗结束后 3.2±1.0 天接受利妥昔单抗治疗。初始利妥昔单抗治疗四周后，所有患者的 mRS 评分和 CD19+B 细胞计数均明显低于治疗前（P<0.05）。末次随访（44.1 个月，17.7 S.D.）时，所有患者均恢复良好（mRS≤2），14 例（77.8%）完全恢复（mRS=0），3 例复发癫痫，1 例出现精神和语言障碍。2 例患者在输注过程中出现短暂轻度不良反应，无其他患者在住院或随访期间出现严重不良反应。
利妥昔单抗治疗一线药物难治性无肿瘤抗 NMDAR 脑炎安全有效。
