不同口服泼尼松渐减疗程对成人抗NMDAR脑炎的疗效和安全性：一项多中心前瞻性队列研究。

IF 6.6 1区医学 Q1 CLINICAL NEUROLOGY

Epilepsia Pub Date : 2024-09-26 DOI:10.1111/epi.18107

Linjun Cai, Gaowei Li, Ammar T. Abdulaziz, Xue Gong, Xu Liu, Xueying Kong, Kundian Guo, Aiqing Li, Jinmei Li, Dong Zhou, Zhen Hong

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引用次数: 0

摘要

目的：在成人抗 N-甲基-d-天冬氨酸受体（NMDAR）脑炎中，皮质类固醇通常被用作一线治疗。然而，静脉注射甲基强的松龙脉冲疗法后的最佳口服强的松减量（OPT）仍不明确。我们旨在比较不同 OPT 疗程对抗 NMDAR 脑炎的疗效和安全性：CHASE研究是一项多中心前瞻性观察性队列研究，从2011年10月至2023年3月招募了自身免疫性脑炎患者。根据患者的口服泼尼松减量疗程进行分组：≤3个月（≤3个月组）、3-6个月（3-6个月组，包括3个月）和>6个月（>6个月组）。采用卡普兰-梅耶图分析复发时间和2年内完全康复时间：在 666 名接受筛查的患者中，171 人（中位数[IQR]年龄为 27 [21.0-36.5] 岁，55.0% 为女性）符合入选标准。3个月后有反应的患者在≤3个月组和3-6个月组中的比例分别为7.251 OR [95% CI 2.252至23.344]和3.857 OR [95% CI 1.107至13.440]，高于6个月以上组。自身免疫性脑炎临床评估量表（CASE）在12个月时的评分，＞6个月组高于≤3个月组和3-6个月组（β，-2.329 [95% CI -3.784至-.875]；β，-2.871 [95% CI -4.490，-1.253]）。大于 6 个月组的 CASE 癫痫发作次评分高于 3-6 个月组（β，-.452 [95% CI -.788 to -.116]）。各组的癫痫发作自由率无明显差异。3-6个月组和＞6个月组的不良事件发生率高于≤3个月组（OR 6.045 [95% CI 2.352 to 15.538]; OR 6.782 [95% CI 1.911 to 24.073]）：在改善改良Rankin量表（mRS）评分和CASE评分、降低2年内复发风险或实现癫痫发作自由方面，对抗NMDAR脑炎成人患者口服较长疗程的泼尼松并未显示出优于较短疗程的效果。相反，延长泼尼松疗程可能会导致更多副作用，尤其是体重增加。这一结果建议在对患者进行全面评估后，评估缩短口服泼尼松疗程的可能性。

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Efficacy and safety of different oral prednisone tapering courses in adult anti-NMDAR encephalitis: A multicenter prospective cohort study

Objective

In adult anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis, corticosteroids are commonly used as first-line treatment. However, the optimal oral prednisone tapering (OPT) following intravenous methylprednisolone pulse therapy remains unclear. We aim to compare the efficacy and safety of different OPT courses in anti-NMDAR encephalitis.

Methods

The CHASE study, a multicenter prospective observational cohort study, enrolled patients with autoimmune encephalitis from October 2011 to March 2023. Patients were grouped based on oral prednisone tapering course: ≤3 months (Group ≤3 month), 3–6 months (Group 3–6 months, including 3 months), and >6 months (Group > 6 months). Kaplan–Meier plots were used to analyze time to relapse and time to total recovery within 2 years.

Results

Among 666 screened patients, 171 (median [IQR] age 27 [21.0–36.5] years, 55.0% female) met selection criteria. Responders at 3 months were prevalent in Group ≤3 months (OR 7.251 [95% CI 2.252 to 23.344] and Group 3–6 months (OR, 3.857 [95% CI 1.107 to 13.440] than in Group >6 months. Clinical Assessment Scale for Autoimmune Encephalitis (CASE) scores at 12 months were higher in Group >6 months than in Group ≤3 months and Group 3–6 months (β, −2.329 [95% CI −3.784 to −.875]; β, −2.871 [95% CI −4.490, −1.253]). CASE seizures subscore was higher in Group >6 months than in Group 3–6 months (β, −.452 [95% CI −.788 to −.116]). No significant difference in seizure freedom rates among the groups. Adverse events were higher in Group 3–6 months and Group >6 months than in Group ≤3 months (OR 6.045 [95% CI 2.352 to 15.538]; OR 6.782 [95% CI 1.911 to 24.073]).

Significance

Longer oral prednisone courses for adult patients with anti-NMDAR encephalitis did not show superior effects compared to shorter courses in improving modified Rankin Scale (mRS) scores and CASE scores, reducing the risk of relapse within 2 years, or achieving seizure freedom. Instead, extended prednisone courses may lead to more side effects— particularly weight gain. This outcome recommends evaluating the possibility of shortening the duration of oral prednisone after a thorough patient assessment.

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来源期刊

Epilepsia 医学-临床神经学

CiteScore

10.90

自引率

10.70%

发文量

319

审稿时长

2-4 weeks

期刊介绍： Epilepsia is the leading, authoritative source for innovative clinical and basic science research for all aspects of epilepsy and seizures. In addition, Epilepsia publishes critical reviews, opinion pieces, and guidelines that foster understanding and aim to improve the diagnosis and treatment of people with seizures and epilepsy.