JAMA Neuro: "Magic Oil" immunotherapy is really omnipotent!

The data currently available indicate that immunotherapy has been proven to improve the prognosis of patients with N-methyl-d-aspartate receptor (NMDAR) antibody encephalitis (NMDARE) and reduce recurrence; therefore, immunotherapy has become the first line of clinical practice Treatment plan
.

However, the superiority of specific treatment methods and combinations remains unclear

Immunization therefore immunotherapy has become the first-line clinical treatment

Children's JAMA

From the beginning to January 1, 2019, the researchers systematically searched published articles in PubMed, including NMDAR antibody-positive NMDARE patients and available individual immunotherapy data
.

Individual patient data extracted about immunotherapy, clinical characteristics at the onset, disease process, and final functional outcome (modified Rankin Scale [mRS] score) were input into a multivariate logistic regression model

The main results are functional results (good: mRS 0-2; poor: mRS>2) and uniphasic disease course (no recurrence for more than 24 months after the onset)
.

The results were used to evaluate the data of 1,550 patients in 652 articles
.

Among them, 1105 (73.

Factors that are significantly associated with good functional outcomes at first onset include age (adolescents) and first-line treatment options: globulin, corticosteroids plus intravenous immunoglobulin (IVIG), or corticosteroids plus IVIG plus therapeutic globulin

Factors significantly associated with adverse functional outcomes are age younger than 2 or 65 years of age at the time of onset, admission to the intensive care unit, extreme delta brush patterns on the EEG, no immunotherapy within the first 30 days of onset, and maintenance of IVIG use More than 6 months

Relationship between age and gender at onset and mRS score

The factors that are significantly related to non-recurrent disease are the use of rituximab or maintenance IVIG for more than 6 months
.

The age at the onset of adolescents is significantly related to recurrent disease

The factors that are significantly related to non-recurrent disease are the use of rituximab or maintenance IVIG for more than 6 months

In summary, the factors that affect the functional outcome and recurrence of NMDARE patients are different, but the use of IVIG for the first onset can indeed improve the prognosis of patients

references:

Use and Safety of Immunotherapeutic Management of N-Methyl-d-Aspartate Receptor Antibody Encephalitis: A Meta-analysis.

Use and Safety of Immunotherapeutic Management of N-Methyl-d-Aspartate Receptor Antibody Encephalitis: A Meta-analysis.
Leave a message here