A Systematic Review and Meta-Analysis of the Recurrence of Autoimmune Encephalitis

IF 3.9 2区医学 Q1 CLINICAL NEUROLOGY

Annals of Clinical and Translational Neurology Pub Date : 2026-08-17 Epub Date: 2026-02-22 DOI:10.1002/acn3.70348

Shangkai Bai, Sen Zhang, Haipei Zhang, Yating Zhang, Junhong Guo, Xiaoyan Yang

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引用次数: 0

Abstract

Objective

Autoimmune encephalitis (AE) is a disease with a potential for recurrence, and patients receive immunotherapy to prevent it. However, there is no consensus on the duration of immunotherapy. This study aimed to determine the recurrence rate and identify the risk factors for AE to provide guidance on the duration of immunotherapy.

Methods

A comprehensive search of the Embase, Web of Science, Cochrane, and PubMed databases was conducted from database inception until January 18, 2025, to identify clinical studies and observational studies reporting the recurrence of AE. Data on recurrence rates across different AE subtypes, age groups, treatments, and follow-up durations were aggregated. A generalized linear model was employed for regression and multivariate regression analyses.

Results

Of the 7892 publications initially identified, 39 observational studies were ultimately included. The overall recurrence rate of AE was 0.162 (95% CI, 0.121–0.207). The recurrence rate for anti-NMDAR encephalitis was 0.148 (95% CI, 0.108–0.193) and significantly decreased after teratoma removal. Second-line treatment decreased the AE recurrence rate. Multivariate regression analysis indicated that having anti-LGI1 encephalitis, age, and shorter delayed treatment duration were risk factors for recurrence. After 1 year of follow-up, the recurrence rate did not increase.

Interpretation

Based on the findings, we recommend proactive second-line immunotherapy for patients with AE to reduce recurrence rates, particularly for those with anti-LGI1 encephalitis and adult individuals. Immunotherapy maintenance over 1 year may not be required.

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自身免疫性脑炎复发的系统回顾和荟萃分析

目的：自身免疫性脑炎（AE）是一种具有复发潜力的疾病，患者接受免疫治疗以预防其复发。然而，对免疫治疗的持续时间没有共识。本研究旨在确定AE的复发率，确定AE的危险因素，为免疫治疗的持续时间提供指导。方法：从数据库建立到2025年1月18日，对Embase、Web of Science、Cochrane和PubMed数据库进行全面检索，以确定报告AE复发的临床研究和观察性研究。汇总不同AE亚型、年龄组、治疗和随访时间的复发率数据。采用广义线性模型进行回归和多元回归分析。结果：在最初确定的7892篇出版物中，39篇观察性研究最终被纳入。AE的总复发率为0.162 （95% CI, 0.121 ~ 0.207）。抗nmdar脑炎复发率为0.148 (95% CI, 0.108 ~ 0.193)，畸胎瘤切除后复发率显著降低。二线治疗降低AE复发率。多因素回归分析显示，抗lgi1脑炎、年龄、延迟治疗时间较短是复发的危险因素。随访1年后，复发率未见增加。结论：基于研究结果，我们建议对AE患者进行积极的二线免疫治疗，以降低复发率，特别是对那些患有抗lgi1脑炎的患者和成年人。免疫治疗维持可能不需要超过1年。

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

Annals of Clinical and Translational Neurology Medicine-Neurology (clinical)

CiteScore

9.10

自引率

1.90%

发文量

218

审稿时长

8 weeks

期刊介绍： Annals of Clinical and Translational Neurology is a peer-reviewed journal for rapid dissemination of high-quality research related to all areas of neurology. The journal publishes original research and scholarly reviews focused on the mechanisms and treatments of diseases of the nervous system; high-impact topics in neurologic education; and other topics of interest to the clinical neuroscience community.