Multicenter experience with Efgartigimod in the treatment of anti-NMDAR encephalitis compared with IVIG and SPA-IA during acute attacks

IF 5.2 2区医学 Q1 MEDICINE, RESEARCH & EXPERIMENTAL

Life sciences Pub Date : 2025-04-01 DOI:10.1016/j.lfs.2025.123597

Jia Liu , Min Li , Junyu Liu , Dong Zheng , Yanxia Zhou , Yi Li , Xialing Chen , Yanni Lin , Lu Yang , Xiaofeng Xu , Ying Jiang , Fuhua Peng

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Abstract

Objectives

The purpose of this study was to evaluate the efficacy of Efgartigimod (EFG) in anti-N-methyl-d-aspartate receptor (anti-NMDAR) encephalitis patients during acute attacks.

Methods

A case-control study was designed to compare 26 anti-NMDAR encephalitis patients who were treated with EFG, and 15 patients with intravenous immunoglobulin (IVIG), and 23 patients with immunoadsorption with staphylococcal protein A column (SPA-IA) treatment.

Results

At baseline, no significant differences in mRS scores were observed among the EFG, IVIG, and SPA-IA groups of anti-NMDAR encephalitis patients. When compared with the IVIG group, patients treated with EFG had significantly decreased serum IgG levels. Compared with the SPA-IA group, EFG-treated patients had lower CSF anti-NMDAR antibody titers at admission (p = 0.039) and higher post-treatment IgG levels (p = 0.002). When compared with the IVIG group, SPA-IA patients had higher CASE scores (p = 0.022) and baseline IgG levels (p = 0.023). All groups improved the symptoms of anti-NMDAR encephalitis patients after treatment during acute attacks, with significant decreases in mRS and CASE scores from admission to discharge (p < 0.01). In the EFG and SPA-IA groups, there was a significant reduction in anti-NMDAR antibody titers in both CSF and serum (p < 0.01), while no remarkable decrease was found in the IVIG group. Additionally, serum IgG levels significantly decreased in both the EFG and SPA-IA groups post treatment and during the 1-month follow-up. By the 3-month of follow-up, IgG levels in the blood of both groups remained below the baseline levels.

Conclusion

EFG could be an elegant alternative to both IVIG and SPA-IA therapies for anti-NMDAR encephalitis during acute attacks. It has a better effect on reducing antibody titers than IVIG and is comparable to SPA-IA therapy, and no serious adverse events were observed during infusion.

查看原文本刊更多论文

依加替莫德治疗急性发作期抗nmdar脑炎与IVIG和SPA-IA的多中心比较

研究目的本研究旨在评估乙加替莫德（EFG）对急性发作期抗N-甲基-d-天冬氨酸受体（抗NMDAR）脑炎患者的疗效：方法：设计了一项病例对照研究，比较了26例接受EFG治疗的抗NMDAR脑炎患者、15例接受静脉注射免疫球蛋白（IVIG）治疗的患者以及23例接受免疫吸附葡萄球菌蛋白A柱（SPA-IA）治疗的患者：基线时，EFG、IVIG 和 SPA-IA 组抗 NMDAR 脑炎患者的 mRS 评分无明显差异。与 IVIG 组相比，接受 EFG 治疗的患者血清 IgG 水平明显下降。与 SPA-IA 组相比，接受 EFG 治疗的患者入院时 CSF 抗 NMDAR 抗体滴度较低（p = 0.039），治疗后 IgG 水平较高（p = 0.002）。与 IVIG 组相比，SPA-IA 患者的 CASE 评分（p = 0.022）和基线 IgG 水平（p = 0.023）均较高。所有组别在急性发作期治疗后都改善了抗 NMDAR 脑炎患者的症状，从入院到出院，mRS 和 CASE 评分均显著下降（p 结论：EFG 可作为抗 NMDAR 脑炎的有效替代疗法：对于急性发作期的抗 NMDAR 脑炎，EFG 可作为 IVIG 和 SPA-IA 疗法的理想替代品。它在降低抗体滴度方面的效果优于 IVIG，与 SPA-IA 疗法不相上下，而且在输注过程中未发现严重不良反应。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Life sciences 医学-药学

CiteScore

12.20

自引率

1.60%

发文量

841

审稿时长

6 months

期刊介绍： Life Sciences is an international journal publishing articles that emphasize the molecular, cellular, and functional basis of therapy. The journal emphasizes the understanding of mechanism that is relevant to all aspects of human disease and translation to patients. All articles are rigorously reviewed. The Journal favors publication of full-length papers where modern scientific technologies are used to explain molecular, cellular and physiological mechanisms. Articles that merely report observations are rarely accepted. Recommendations from the Declaration of Helsinki or NIH guidelines for care and use of laboratory animals must be adhered to. Articles should be written at a level accessible to readers who are non-specialists in the topic of the article themselves, but who are interested in the research. The Journal welcomes reviews on topics of wide interest to investigators in the life sciences. We particularly encourage submission of brief, focused reviews containing high-quality artwork and require the use of mechanistic summary diagrams.