Acute and Long-Term Immune-Treatment Strategies in Anti-LGI1 Antibody-Mediated Encephalitis: A Multicenter Cohort Study.

IF 7.8 1区医学 Q1 CLINICAL NEUROLOGY

Neurology® Neuroimmunology & Neuroinflammation Pub Date : 2025-07-01 Epub Date: 2025-06-19 DOI:10.1212/NXI.0000000000200412

Nabil Seery, Robb Wesselingh, Paul Beech, Laurie M McLaughlin, Tiffany Rushen, Amy J Halliday, Liora Ter Horst, Sarah P Griffith, Mirasol Forcadela, Tracie H Tan, Christina Kazzi, Cassie Nesbitt, James Broadley, Katherine Buzzard, Andrew J Duncan, Wendyl Jude D'Souza, Yang David Tran, Anneke Van Der Walt, Genevieve Skinner, Bruce V Taylor, Andrew Swayne, Amy Brodtmann, David Gillis, Ernest Gerard Butler, Tomas Kalincik, Udaya K Seneviratne, Richard A Macdonell, Stefan Blum, Sudarshini Ramanathan, Charles B Malpas, Stephen William Reddel, Todd A Hardy, Terence J O'Brien, Paul G Sanfilippo, Helmut Butzkueven, Mastura Monif

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Abstract

Background and objectives: Few studies have evaluated acute immunotherapy and relapse prevention strategies in patients with anti-leucine-rich glioma-inactivated 1 (LGI1) antibody (Ab)-mediated encephalitis. The objective of this study was to analyze the outcomes of acute and long-term immunotherapy strategies in this population.

Methods: We undertook a multicenter cohort study of 55 patients with anti-LGI1 Ab-mediated encephalitis, either recruited prospectively or identified retrospectively from 10 Australian hospitals as part of the Australian Autoimmune Encephalitis Consortium. Clinical data were collected, including treatment durations of all relevant immunotherapies. Clinical outcomes that we examined included (1) time to first clinical relapse, (2) improvement on modified Rankin Scale (mRS), and (3) favorable binary composite clinical-functional outcome at 12 months. A favorable outcome was defined as fulfilling all three of mRS less than 3, a score of 1 or less in the memory dysfunction component of the Clinical Assessment Scale in Autoimmune Encephalitis, and absence of drug-resistant epilepsy.

Results: Rituximab, adjusted for concomitant use of other immunotherapies, was associated with increased time to first relapse (hazard ratio 0.10; 95% CI 0.001-0.85; p = 0.03). Intravenous pulsed methylprednisolone was associated with an improvement in mRS (OR 4.48; 95% CI 1.03-21.3; p = 0.048) and a favorable composite clinical-functional outcome (OR 4.96; 95% CI 1.07-27.2; p = 0.049) at 12 months.

Discussion: Rituximab may be effective at preventing relapses in patients with anti-LGI1 Ab-mediated encephalitis. Acute methylprednisolone treatment may be associated with favorable outcomes at 12 months.

Classification of evidence: This study provides Class IV evidence that for patients with anti-LGI1 Ab-mediated encephalitis, rituximab prevents relapses and acute methylprednisolone is associated with favorable outcomes at 12 months.

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抗lgi1抗体介导的脑炎的急性和长期免疫治疗策略：一项多中心队列研究

背景和目的：很少有研究评估抗富亮氨酸胶质瘤失活1 （LGI1）抗体（Ab）介导的脑炎患者的急性免疫治疗和复发预防策略。本研究的目的是分析该人群的急性和长期免疫治疗策略的结果。方法：我们对55例抗lgi1抗体介导的脑炎患者进行了一项多中心队列研究，这些患者要么是前瞻性招募的，要么是回顾性确定的，来自澳大利亚10家医院，作为澳大利亚自身免疫性脑炎联盟的一部分。收集临床数据，包括所有相关免疫疗法的治疗时间。我们检查的临床结果包括(1)到首次临床复发的时间，(2)改良Rankin量表（mRS）的改善，以及(3)12个月时良好的二元复合临床功能结果。良好的预后定义为mRS三项均小于3分，自身免疫性脑炎临床评估量表记忆功能障碍部分得分为1分或更低，无耐药癫痫。结果：利妥昔单抗与其他免疫疗法的同时使用，与首次复发的时间增加相关(风险比0.10；95% ci 0.001-0.85；P = 0.03)。静脉注射甲基强的松龙与mRS改善相关(OR 4.48；95% ci 1.03-21.3；p = 0.048)和良好的临床功能综合结局(OR 4.96；95% ci 1.07-27.2；P = 0.049)。讨论：利妥昔单抗可能有效预防抗lgi1抗体介导的脑炎患者复发。急性甲基强的松龙治疗可能与12个月时的良好预后相关。证据分类：该研究提供了IV级证据，证明抗lgi1抗体介导的脑炎患者，利妥昔单抗可预防复发，急性甲基强的松龙与12个月时的良好预后相关。

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

Neurology® Neuroimmunology & Neuroinflammation Neuroscience-Neurology

CiteScore

15.60

自引率

2.30%

发文量

219

审稿时长

8 weeks

期刊介绍： Neurology Neuroimmunology & Neuroinflammation is an official journal of the American Academy of Neurology. Neurology: Neuroimmunology & Neuroinflammation will be the premier peer-reviewed journal in neuroimmunology and neuroinflammation. This journal publishes rigorously peer-reviewed open-access reports of original research and in-depth reviews of topics in neuroimmunology & neuroinflammation, affecting the full range of neurologic diseases including (but not limited to) Alzheimer's disease, Parkinson's disease, ALS, tauopathy, and stroke; multiple sclerosis and NMO; inflammatory peripheral nerve and muscle disease, Guillain-Barré and myasthenia gravis; nervous system infection; paraneoplastic syndromes, noninfectious encephalitides and other antibody-mediated disorders; and psychiatric and neurodevelopmental disorders. Clinical trials, instructive case reports, and small case series will also be featured.