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Lower dosages of rituximab used successfully in the treatment of anti-NMDA receptor encephalitis without tumour.
J Neurol Sci. 2017 Jun 15; 377:127-132.JN

Abstract

OBJECTIVE

The aim of this study was to evaluate the use and efficacy of lower dosages of rituximab for treating anti N-methyl-d-aspartate receptor (NMDAR) encephalitis without tumour.

METHODS

We performed a prospective study of 10 patients with anti-NMDAR encephalitis who did not respond to 10 to 14days first-line immunotherapy and received rituximab administered intravenously (IV) at a dosage of 100mg once per week for 4 consecutive weeks. Reinfusion of rituximab was given when CD19+ B-cell counts of total lymphocytes in peripheral blood >1%. The annualized relapse rate (ARR), modified Rankin scale (mRS) and CD19+ B-cell counts were measured every 4 to 10weeks after initial rituximab treatment in order to assess the clinical outcome and efficacy of rituximab.

RESULTS

Lower dosages of rituximab led to a significant reduction of mRS and CD19+ B-cells when compared with before the rituximab infusion (P<0.05) and allowed 9 (90%) patients to maintain a stabilised neurological status. One patient experienced a relapse at 19weeks after initial rituximab infusion. Although ARR reduction of all 10 patients did not achieve statistical significance (P>0.05), in the 4 patients who had relapses before rituximab treatment there was an apparent reduction in ARR over 56weeks. At the last follow up, 9 patients (90%) had a good outcome (mRS≤2) including 3 patients (30%) who recovered completely (mRS=0). Transient infusion adverse events occurred in 2 patients. We observed no serious delayed adverse events during the 56weeks follow-up.

CONCLUSIONS

In patients with anti-NMDAR encephalitis who did not respond to first-line immunotherapy, early application of lower dosages of rituximab could efficiently reduce CD19+ B-cell counts of peripheral blood and improve the prognosis of anti-NMDAR encephalitis.

Authors+Show Affiliations

Department of Neurology, Shandong Provincial Hospital affiliated to Shandong University, Jing Wu Road, Huaiyin District, Jinan 250021, Shandong, China.Department of Neurology, Shandong Provincial Hospital affiliated to Shandong University, Jing Wu Road, Huaiyin District, Jinan 250021, Shandong, China.Department of Neurology, Shandong Provincial Hospital affiliated to Shandong University, Jing Wu Road, Huaiyin District, Jinan 250021, Shandong, China.Department of Neurology, Shandong Provincial Hospital affiliated to Shandong University, Jing Wu Road, Huaiyin District, Jinan 250021, Shandong, China.Department of Neurology, Shandong Provincial Hospital affiliated to Shandong University, Jing Wu Road, Huaiyin District, Jinan 250021, Shandong, China. Electronic address: guoshougang1124@163.com.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28477682

Citation

Wang, Bao-Jie, et al. "Lower Dosages of Rituximab Used Successfully in the Treatment of anti-NMDA Receptor Encephalitis Without Tumour." Journal of the Neurological Sciences, vol. 377, 2017, pp. 127-132.
Wang BJ, Wang CJ, Zeng ZL, et al. Lower dosages of rituximab used successfully in the treatment of anti-NMDA receptor encephalitis without tumour. J Neurol Sci. 2017;377:127-132.
Wang, B. J., Wang, C. J., Zeng, Z. L., Yang, Y., & Guo, S. G. (2017). Lower dosages of rituximab used successfully in the treatment of anti-NMDA receptor encephalitis without tumour. Journal of the Neurological Sciences, 377, 127-132. https://doi.org/10.1016/j.jns.2017.04.007
Wang BJ, et al. Lower Dosages of Rituximab Used Successfully in the Treatment of anti-NMDA Receptor Encephalitis Without Tumour. J Neurol Sci. 2017 Jun 15;377:127-132. PubMed PMID: 28477682.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Lower dosages of rituximab used successfully in the treatment of anti-NMDA receptor encephalitis without tumour. AU - Wang,Bao-Jie, AU - Wang,Chun-Juan, AU - Zeng,Zi-Ling, AU - Yang,Yang, AU - Guo,Shou-Gang, Y1 - 2017/04/08/ PY - 2016/11/30/received PY - 2017/03/10/revised PY - 2017/04/06/accepted PY - 2017/5/8/entrez PY - 2017/5/10/pubmed PY - 2018/2/24/medline KW - Anti-NMDA receptor encephalitis KW - Immunotherapy KW - Relapse KW - Rituximab SP - 127 EP - 132 JF - Journal of the neurological sciences JO - J. Neurol. Sci. VL - 377 N2 - OBJECTIVE: The aim of this study was to evaluate the use and efficacy of lower dosages of rituximab for treating anti N-methyl-d-aspartate receptor (NMDAR) encephalitis without tumour. METHODS: We performed a prospective study of 10 patients with anti-NMDAR encephalitis who did not respond to 10 to 14days first-line immunotherapy and received rituximab administered intravenously (IV) at a dosage of 100mg once per week for 4 consecutive weeks. Reinfusion of rituximab was given when CD19+ B-cell counts of total lymphocytes in peripheral blood >1%. The annualized relapse rate (ARR), modified Rankin scale (mRS) and CD19+ B-cell counts were measured every 4 to 10weeks after initial rituximab treatment in order to assess the clinical outcome and efficacy of rituximab. RESULTS: Lower dosages of rituximab led to a significant reduction of mRS and CD19+ B-cells when compared with before the rituximab infusion (P<0.05) and allowed 9 (90%) patients to maintain a stabilised neurological status. One patient experienced a relapse at 19weeks after initial rituximab infusion. Although ARR reduction of all 10 patients did not achieve statistical significance (P>0.05), in the 4 patients who had relapses before rituximab treatment there was an apparent reduction in ARR over 56weeks. At the last follow up, 9 patients (90%) had a good outcome (mRS≤2) including 3 patients (30%) who recovered completely (mRS=0). Transient infusion adverse events occurred in 2 patients. We observed no serious delayed adverse events during the 56weeks follow-up. CONCLUSIONS: In patients with anti-NMDAR encephalitis who did not respond to first-line immunotherapy, early application of lower dosages of rituximab could efficiently reduce CD19+ B-cell counts of peripheral blood and improve the prognosis of anti-NMDAR encephalitis. SN - 1878-5883 UR - https://www.unboundmedicine.com/medline/citation/28477682/Lower_dosages_of_rituximab_used_successfully_in_the_treatment_of_anti_NMDA_receptor_encephalitis_without_tumour_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-510X(17)30241-1 DB - PRIME DP - Unbound Medicine ER -