Zhang Lin-Ming, Xing Xuan-Lin, Zhang Bing-Ran, Zhang Qiu-Juan, Zhu Yan-Lin, Gao Shu-Ji, Liu Ming-Wei
Department of Neurology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, 650032, China.
Department of Emergency, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, 650032, China.
Heliyon. 2025 Jan 7;11(2):e41747. doi: 10.1016/j.heliyon.2025.e41747. eCollection 2025 Jan 30.
Approximately 20%-50 % of individuals with autoimmune encephalitis (AE) demonstrate suboptimal responses to first-line therapies, leading to persistent neurological deficits and the need for second-line interventions. Although rituximab has shown potential as an alternative treatment in AE, the existing evidence remains insufficient. This study systematically evaluated and meta-analyzed the efficacy of rituximab in AE patients who either failed or exhibited inadequate responses to first-line treatments, aiming to refine and optimize therapeutic strategies for AE.
A comprehensive search of PubMed, Embase, and the Cochrane Library databases was conducted, covering studies published up to June 10, 2024. In addition, manual cross-referencing of relevant studies was performed using both subject-specific and free-text terms such as "Rituximab," "Rituxan," "Mabthera," "RTX," "Mab," "Ma," "AE," "encephalitis," "Anti-NMDAR encephalitis," and "autoimmune encephalitis." Data on rituximab's efficacy as a second-line therapy in AE were independently screened and extracted by two researchers. Statistical analyses were conducted using R4.2.1 software to assess the pooled outcomes of the included studies.
Analysis of 14 studies involving 277 AE cases revealed an 80 % favorable prognosis rate (0.72-0.89) for rituximab, with superior efficacy in patients under 18 years compared to those over 18 (I = 65.9 %, 38.7%-81.0 %; < 0.01). The prognosis rate for patients under 18 was 0.85 (0.76-0.93), while for those over 18, it was 0.72 (0.56-0.88). Furthermore, a disease duration of ≤180 days correlated with a better prognosis than durations exceeding 180 days, with rates of 0.82 (0.69-0.94) and 0.74 (0.61-0.87), respectively.
Rituximab demonstrates an 80 % favorable prognosis rate in AE cases unresponsive to first-line treatments, particularly in patients under 18 or those with disease duration ≤180 days.
约20%-50%的自身免疫性脑炎（AE）患者对一线治疗反应欠佳，导致持续性神经功能缺损，需要二线干预。尽管利妥昔单抗已显示出作为AE替代治疗的潜力，但现有证据仍不充分。本研究系统评价并荟萃分析了利妥昔单抗在一线治疗失败或反应不足的AE患者中的疗效，旨在完善和优化AE的治疗策略。
全面检索了PubMed、Embase和Cochrane图书馆数据库，涵盖截至2024年6月10日发表的研究。此外，使用“利妥昔单抗”“美罗华”“ Mabthera”“RTX”“单克隆抗体”“Ma”“AE”“脑炎”“抗NMDAR脑炎”和“自身免疫性脑炎”等主题词和自由文本词对相关研究进行手动交叉引用。两名研究人员独立筛选并提取了利妥昔单抗作为AE二线治疗疗效的数据。使用R4.2.1软件进行统计分析，以评估纳入研究的汇总结果。
对14项涉及277例AE病例的研究分析显示，利妥昔单抗的预后良好率为80%（0.72-0.89），18岁以下患者的疗效优于18岁以上患者（I=65.9%，38.7%-81.0%；P<0.01）。18岁以下患者的预后率为0.85（0.76-0.93），而18岁以上患者的预后率为0.72（0.56-0.88）。此外，疾病持续时间≤180天的患者预后优于超过180天的患者，预后率分别为0.82（0.69-0.94）和0.74（0.61-0.87）。
利妥昔单抗在对一线治疗无反应的AE病例中显示出80%的良好预后率，特别是在18岁以下或疾病持续时间≤180天的患者中。
