Miao Su, Zichao Wu, Qiuyan Luo, Huiyu Feng, Hongyan Zhou
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However, whether a shorter delay of PE or IA can improve the early recovery prognosis of patients with anti-NMDAR encephalitis remains largely unknown.</p><p><strong>Objective: </strong>To compare short-term clinical improvement between patients with early and late initiation of PE or IA in anti-NMDAR encephalitis.</p><p><strong>Design: </strong>A retrospective study was conducted for patients admitted with anti-NMDAR encephalitis between January 2015 and December 2023 (<i>n</i> = 29), including 21 patients who received PE or IA as synergistic therapies.</p><p><strong>Methods: </strong>The clinical prognosis was compared between the early PE/IA group and the late PE/IA group in the research. Primary outcome included changes in the Clinical Assessment Scale for Autoimmune Encephalitis (∆CASE) at 90 and 120 days after encephalitis onset. Secondary outcomes included changes in the modified Rankin scale (∆mRS) after 90 and 120 days from encephalitis onset, and the length of intensive care unit (ICU) stay for patients with severe anti-NMDAR encephalitis.</p><p><strong>Results: </strong>The ∆CASE scores after 90 and 120 days from encephalitis onset revealed a significant difference between patients with early and late initiation of PE or IA (<i>p</i> ⩽ 0.05). A significant difference in the ∆mRS was also found between patients with early and late initiation of PE or IA in severe encephalitis (<i>p</i> ⩽ 0.05). No significant difference was found in the length of ICU admission (<i>p</i> = 0.101).</p><p><strong>Conclusion: </strong>Our findings emphasize the importance of considering PE or IA as early as feasible for patients with anti-NMDAR encephalitis, even when steroids and IVIG are in use.</p>","PeriodicalId":22980,"journal":{"name":"Therapeutic Advances in Neurological Disorders","volume":"17 ","pages":"17562864241276208"},"PeriodicalIF":4.7000,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11561987/pdf/","citationCount":"0","resultStr":"{\"title\":\"Short delay to initiate plasma exchange or immunoadsorption as synergistic therapies for patients in the acute phase of anti-NMDAR encephalitis.\",\"authors\":\"Miao Su, Zichao Wu, Qiuyan Luo, Huiyu Feng, Hongyan Zhou\",\"doi\":\"10.1177/17562864241276208\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Combined first-line therapies have been frequently adopted for patients with anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis. Plasma exchange (PE) or immunoadsorption (IA) was used as an add-on option following initial immunotherapies, including high-dose steroids and intravenous immunoglobulin (IVIG). However, whether a shorter delay of PE or IA can improve the early recovery prognosis of patients with anti-NMDAR encephalitis remains largely unknown.</p><p><strong>Objective: </strong>To compare short-term clinical improvement between patients with early and late initiation of PE or IA in anti-NMDAR encephalitis.</p><p><strong>Design: </strong>A retrospective study was conducted for patients admitted with anti-NMDAR encephalitis between January 2015 and December 2023 (<i>n</i> = 29), including 21 patients who received PE or IA as synergistic therapies.</p><p><strong>Methods: </strong>The clinical prognosis was compared between the early PE/IA group and the late PE/IA group in the research. Primary outcome included changes in the Clinical Assessment Scale for Autoimmune Encephalitis (∆CASE) at 90 and 120 days after encephalitis onset. Secondary outcomes included changes in the modified Rankin scale (∆mRS) after 90 and 120 days from encephalitis onset, and the length of intensive care unit (ICU) stay for patients with severe anti-NMDAR encephalitis.</p><p><strong>Results: </strong>The ∆CASE scores after 90 and 120 days from encephalitis onset revealed a significant difference between patients with early and late initiation of PE or IA (<i>p</i> ⩽ 0.05). A significant difference in the ∆mRS was also found between patients with early and late initiation of PE or IA in severe encephalitis (<i>p</i> ⩽ 0.05). 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引用次数: 0
摘要
背景:抗 N-甲基-D-天冬氨酸受体(anti-NMDAR)脑炎患者经常采用一线联合疗法。血浆置换(PE)或免疫吸附(IA)被用作初始免疫疗法(包括大剂量类固醇和静脉注射免疫球蛋白(IVIG))后的附加疗法。然而,缩短 PE 或 IA 的延迟时间是否能改善抗 NMDAR 脑炎患者的早期康复预后仍是一个未知数:比较抗 NMDAR 脑炎患者早期和晚期开始 PE 或 IA 的短期临床改善情况:设计:对2015年1月至2023年12月期间收治的抗NMDAR脑炎患者(n=29)进行回顾性研究,包括21例接受PE或IA协同治疗的患者:研究比较了早期 PE/IA 组和晚期 PE/IA 组的临床预后。主要结果包括脑炎发病后90天和120天时自身免疫性脑炎临床评估量表(ΔCASE)的变化。次要结果包括脑炎发病 90 天和 120 天后改良兰金量表(∆mRS)的变化,以及重症抗 NMDAR脑炎患者在重症监护室(ICU)的住院时间:脑炎发病 90 天和 120 天后的∆CASE 评分显示,早期和晚期开始 PE 或 IA 的患者之间存在显著差异(p ⩽0.05)。在重症脑炎患者中,早期和晚期开始 PE 或 IA 的患者的 ∆mRS 也存在明显差异(p ⩽0.05)。入住重症监护室的时间没有明显差异(p = 0.101):我们的研究结果强调了在可行的情况下尽早考虑对抗NMDAR脑炎患者进行PE或IA治疗的重要性,即使在使用类固醇和IVIG的情况下也是如此。
Short delay to initiate plasma exchange or immunoadsorption as synergistic therapies for patients in the acute phase of anti-NMDAR encephalitis.
Background: Combined first-line therapies have been frequently adopted for patients with anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis. Plasma exchange (PE) or immunoadsorption (IA) was used as an add-on option following initial immunotherapies, including high-dose steroids and intravenous immunoglobulin (IVIG). However, whether a shorter delay of PE or IA can improve the early recovery prognosis of patients with anti-NMDAR encephalitis remains largely unknown.
Objective: To compare short-term clinical improvement between patients with early and late initiation of PE or IA in anti-NMDAR encephalitis.
Design: A retrospective study was conducted for patients admitted with anti-NMDAR encephalitis between January 2015 and December 2023 (n = 29), including 21 patients who received PE or IA as synergistic therapies.
Methods: The clinical prognosis was compared between the early PE/IA group and the late PE/IA group in the research. Primary outcome included changes in the Clinical Assessment Scale for Autoimmune Encephalitis (∆CASE) at 90 and 120 days after encephalitis onset. Secondary outcomes included changes in the modified Rankin scale (∆mRS) after 90 and 120 days from encephalitis onset, and the length of intensive care unit (ICU) stay for patients with severe anti-NMDAR encephalitis.
Results: The ∆CASE scores after 90 and 120 days from encephalitis onset revealed a significant difference between patients with early and late initiation of PE or IA (p ⩽ 0.05). A significant difference in the ∆mRS was also found between patients with early and late initiation of PE or IA in severe encephalitis (p ⩽ 0.05). No significant difference was found in the length of ICU admission (p = 0.101).
Conclusion: Our findings emphasize the importance of considering PE or IA as early as feasible for patients with anti-NMDAR encephalitis, even when steroids and IVIG are in use.
期刊介绍:
Therapeutic Advances in Neurological Disorders is a peer-reviewed, open access journal delivering the highest quality articles, reviews, and scholarly comment on pioneering efforts and innovative studies across all areas of neurology. The journal has a strong clinical and pharmacological focus and is aimed at clinicians and researchers in neurology, providing a forum in print and online for publishing the highest quality articles in this area.