Teratoma Removal, Steroid, IVIG, Rituximab and Tocilizumab (T-SIRT) in Anti-NMDAR Encephalitis
In anti-N-methyl- d -aspartate receptor (NMDAR) encephalitis, we analysed the efficacy of a combined immunotherapy protocol consisting of teratoma removal, steroid, intravenous immunoglobulin (IVIG), rituximab and tocilizumab (T-SIRT). This cohort study included seventy-eight consecutive patients tr...
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| Veröffentlicht in: | Neurotherapeutics 2021-01, Vol.18 (1), p.474-487 |
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| creator | Lee, Woo-Jin Lee, Soon-Tae Shin, Yong-Won Lee, Han Sang Shin, Hye-Rim Kim, Do-Yong Kim, Soyun Lim, Jung-Ah Moon, Jangsup Park, Kyung-Il Kim, Hee Seung Chu, Kon Lee, Sang Kun |
| description | In anti-N-methyl-
d
-aspartate receptor (NMDAR) encephalitis, we analysed the efficacy of a combined immunotherapy protocol consisting of teratoma removal, steroid, intravenous immunoglobulin (IVIG), rituximab and tocilizumab (T-SIRT). This cohort study included seventy-eight consecutive patients treated for anti-NMDAR encephalitis between Jan 2014 and Oct 2019 in a national referral hospital. Detailed 2-year disease time course was analysed using Clinical Assessment Scale for Autoimmune Encephalitis (CASE) scores at every 2 weeks for 12 weeks from baseline, every month for the next 3 months and then every 3 months. Treatment regimens at each time point were categorized as SI, SIR, or SIRT with/without teratoma removal (T). Adverse events were classified according to the Common Terminology Criteria for Adverse-Events (CTCAE v5.0), where a severe adverse event was defined as an adverse event with CATAE grade 4. In a linear mixed model analysis, using the SIRT regimen was more effective than SIR or SI regimens in lowering CASE scores (
P
|
| doi_str_mv | 10.1007/s13311-020-00921-7 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8116457</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2525901574</sourcerecordid><originalsourceid>FETCH-LOGICAL-c474t-6550e6b7b98efb4d6895de72819ab6d0905c71e2923c302b39a78c47ba81fbd3</originalsourceid><addsrcrecordid>eNp9kUlPHDEQhS0EAgL8gRwiS7kQaQxe2m37EmnEOhKLNLQ4xrK7PWDU057Y3Sjh1-NhWJILp6pSvXr1pA-ArwQfEIzFYSKMEYIwxQhjRQkSa2CbSCGRKIRaz71iDAlK2Bb4ktIDxpwxJTfBFqNSYsmLbfCrctH0YW7g1M3Do2lH8KZ3MfhmBCe3k7MRnPp--OPnxkLTNbAKtW_907Cc9yt0M5lWP6Dv4LjrPbq6PB5P4UlXu8W9aX3v0y7YmJk2ub3XugOq05Pq6BxdXJ9NjsYXqC5E0aOSc-xKK6ySbmaLppSKN05QSZSxZYMV5rUgjirKaoapZcoImU-tkWRmG7YDfq5sF4Odu6Z2XR9Nqxcx545_dTBe_7_p_L2-C49aElIWXGSD768GMfweXOr1QxhilyNryilXmHBRZBVdqeoYUopu9v6BYL1EoldIdEaiX5DopfW3f7O9n7wxyAK2EqS86u5c_Pj9ie0zRs6Vrw</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2525901574</pqid></control><display><type>article</type><title>Teratoma Removal, Steroid, IVIG, Rituximab and Tocilizumab (T-SIRT) in Anti-NMDAR Encephalitis</title><source>MEDLINE</source><source>EZB-FREE-00999 freely available EZB journals</source><source>PubMed Central</source><source>Alma/SFX Local Collection</source><source>SpringerLink Journals - AutoHoldings</source><creator>Lee, Woo-Jin ; Lee, Soon-Tae ; Shin, Yong-Won ; Lee, Han Sang ; Shin, Hye-Rim ; Kim, Do-Yong ; Kim, Soyun ; Lim, Jung-Ah ; Moon, Jangsup ; Park, Kyung-Il ; Kim, Hee Seung ; Chu, Kon ; Lee, Sang Kun</creator><creatorcontrib>Lee, Woo-Jin ; Lee, Soon-Tae ; Shin, Yong-Won ; Lee, Han Sang ; Shin, Hye-Rim ; Kim, Do-Yong ; Kim, Soyun ; Lim, Jung-Ah ; Moon, Jangsup ; Park, Kyung-Il ; Kim, Hee Seung ; Chu, Kon ; Lee, Sang Kun</creatorcontrib><description>In anti-N-methyl-
d
-aspartate receptor (NMDAR) encephalitis, we analysed the efficacy of a combined immunotherapy protocol consisting of teratoma removal, steroid, intravenous immunoglobulin (IVIG), rituximab and tocilizumab (T-SIRT). This cohort study included seventy-eight consecutive patients treated for anti-NMDAR encephalitis between Jan 2014 and Oct 2019 in a national referral hospital. Detailed 2-year disease time course was analysed using Clinical Assessment Scale for Autoimmune Encephalitis (CASE) scores at every 2 weeks for 12 weeks from baseline, every month for the next 3 months and then every 3 months. Treatment regimens at each time point were categorized as SI, SIR, or SIRT with/without teratoma removal (T). Adverse events were classified according to the Common Terminology Criteria for Adverse-Events (CTCAE v5.0), where a severe adverse event was defined as an adverse event with CATAE grade 4. In a linear mixed model analysis, using the SIRT regimen was more effective than SIR or SI regimens in lowering CASE scores (
P
< 0.001 and
P
= 0.001, respectively). The presence of teratoma (
P
= 0.001), refractory status epilepticus (
P
< 0.001) and a higher CASE score at baseline (
P
< 0.001) predicted a higher CASE score at each time point. Completion of the (T)-SIRT regimen within 1 month of onset resulted in better 1-year improvements in CASE score (
P
< 0.001) and modified Rankin scale scores (
P
= 0.001), compared to those of using other regimens within 1 month or delaying teratoma removal for more than 1 month. Pneumonia was a frequent adverse event (52/78, 66.7%) in the whole study population and neutropenia was frequent during SIRT (11/52, 21.2%), but the regimen was well tolerated in most patients. We concluded that the early application of combined immunotherapy consisting of T-SIRT had better efficacy than was found for delayed or partial application of this combination in anti-NMDAR encephalitis.</description><identifier>ISSN: 1933-7213</identifier><identifier>ISSN: 1878-7479</identifier><identifier>EISSN: 1878-7479</identifier><identifier>DOI: 10.1007/s13311-020-00921-7</identifier><identifier>PMID: 32880854</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Adolescent ; Adult ; Adverse events ; Aged ; Anti-N-Methyl-D-Aspartate Receptor Encephalitis - therapy ; Antibodies, Monoclonal, Humanized - administration & dosage ; Antibodies, Monoclonal, Humanized - therapeutic use ; Biomedical and Life Sciences ; Biomedicine ; Child ; Combined Modality Therapy ; Drug Therapy, Combination ; Encephalitis ; Epilepsy ; Female ; Glutamate receptors ; Humans ; Immunoglobulins ; Immunoglobulins, Intravenous - therapeutic use ; Immunosuppressive agents ; Immunotherapy ; Intravenous administration ; Male ; Medical prognosis ; Middle Aged ; Monoclonal antibodies ; N-Methyl-D-aspartic acid receptors ; Neurobiology ; Neurology ; Neurosciences ; Neurosurgery ; Neutropenia ; Original ; Original Article ; Ovarian Neoplasms - surgery ; Patient Acuity ; Patients ; Population studies ; Rituximab ; Rituximab - administration & dosage ; Rituximab - therapeutic use ; Teratoma ; Teratoma - surgery ; Terminology ; Testicular Neoplasms - surgery ; Treatment Outcome ; Young Adult</subject><ispartof>Neurotherapeutics, 2021-01, Vol.18 (1), p.474-487</ispartof><rights>The American Society for Experimental NeuroTherapeutics, Inc. 2020</rights><rights>The American Society for Experimental NeuroTherapeutics, Inc. 2020.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c474t-6550e6b7b98efb4d6895de72819ab6d0905c71e2923c302b39a78c47ba81fbd3</citedby><cites>FETCH-LOGICAL-c474t-6550e6b7b98efb4d6895de72819ab6d0905c71e2923c302b39a78c47ba81fbd3</cites><orcidid>0000-0001-5863-0302</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8116457/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8116457/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,723,776,780,881,27901,27902,41464,42533,51294,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32880854$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lee, Woo-Jin</creatorcontrib><creatorcontrib>Lee, Soon-Tae</creatorcontrib><creatorcontrib>Shin, Yong-Won</creatorcontrib><creatorcontrib>Lee, Han Sang</creatorcontrib><creatorcontrib>Shin, Hye-Rim</creatorcontrib><creatorcontrib>Kim, Do-Yong</creatorcontrib><creatorcontrib>Kim, Soyun</creatorcontrib><creatorcontrib>Lim, Jung-Ah</creatorcontrib><creatorcontrib>Moon, Jangsup</creatorcontrib><creatorcontrib>Park, Kyung-Il</creatorcontrib><creatorcontrib>Kim, Hee Seung</creatorcontrib><creatorcontrib>Chu, Kon</creatorcontrib><creatorcontrib>Lee, Sang Kun</creatorcontrib><title>Teratoma Removal, Steroid, IVIG, Rituximab and Tocilizumab (T-SIRT) in Anti-NMDAR Encephalitis</title><title>Neurotherapeutics</title><addtitle>Neurotherapeutics</addtitle><addtitle>Neurotherapeutics</addtitle><description>In anti-N-methyl-
d
-aspartate receptor (NMDAR) encephalitis, we analysed the efficacy of a combined immunotherapy protocol consisting of teratoma removal, steroid, intravenous immunoglobulin (IVIG), rituximab and tocilizumab (T-SIRT). This cohort study included seventy-eight consecutive patients treated for anti-NMDAR encephalitis between Jan 2014 and Oct 2019 in a national referral hospital. Detailed 2-year disease time course was analysed using Clinical Assessment Scale for Autoimmune Encephalitis (CASE) scores at every 2 weeks for 12 weeks from baseline, every month for the next 3 months and then every 3 months. Treatment regimens at each time point were categorized as SI, SIR, or SIRT with/without teratoma removal (T). Adverse events were classified according to the Common Terminology Criteria for Adverse-Events (CTCAE v5.0), where a severe adverse event was defined as an adverse event with CATAE grade 4. In a linear mixed model analysis, using the SIRT regimen was more effective than SIR or SI regimens in lowering CASE scores (
P
< 0.001 and
P
= 0.001, respectively). The presence of teratoma (
P
= 0.001), refractory status epilepticus (
P
< 0.001) and a higher CASE score at baseline (
P
< 0.001) predicted a higher CASE score at each time point. Completion of the (T)-SIRT regimen within 1 month of onset resulted in better 1-year improvements in CASE score (
P
< 0.001) and modified Rankin scale scores (
P
= 0.001), compared to those of using other regimens within 1 month or delaying teratoma removal for more than 1 month. Pneumonia was a frequent adverse event (52/78, 66.7%) in the whole study population and neutropenia was frequent during SIRT (11/52, 21.2%), but the regimen was well tolerated in most patients. We concluded that the early application of combined immunotherapy consisting of T-SIRT had better efficacy than was found for delayed or partial application of this combination in anti-NMDAR encephalitis.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Adverse events</subject><subject>Aged</subject><subject>Anti-N-Methyl-D-Aspartate Receptor Encephalitis - therapy</subject><subject>Antibodies, Monoclonal, Humanized - administration & dosage</subject><subject>Antibodies, Monoclonal, Humanized - therapeutic use</subject><subject>Biomedical and Life Sciences</subject><subject>Biomedicine</subject><subject>Child</subject><subject>Combined Modality Therapy</subject><subject>Drug Therapy, Combination</subject><subject>Encephalitis</subject><subject>Epilepsy</subject><subject>Female</subject><subject>Glutamate receptors</subject><subject>Humans</subject><subject>Immunoglobulins</subject><subject>Immunoglobulins, Intravenous - therapeutic use</subject><subject>Immunosuppressive agents</subject><subject>Immunotherapy</subject><subject>Intravenous administration</subject><subject>Male</subject><subject>Medical prognosis</subject><subject>Middle Aged</subject><subject>Monoclonal antibodies</subject><subject>N-Methyl-D-aspartic acid receptors</subject><subject>Neurobiology</subject><subject>Neurology</subject><subject>Neurosciences</subject><subject>Neurosurgery</subject><subject>Neutropenia</subject><subject>Original</subject><subject>Original Article</subject><subject>Ovarian Neoplasms - surgery</subject><subject>Patient Acuity</subject><subject>Patients</subject><subject>Population studies</subject><subject>Rituximab</subject><subject>Rituximab - administration & dosage</subject><subject>Rituximab - therapeutic use</subject><subject>Teratoma</subject><subject>Teratoma - surgery</subject><subject>Terminology</subject><subject>Testicular Neoplasms - surgery</subject><subject>Treatment Outcome</subject><subject>Young Adult</subject><issn>1933-7213</issn><issn>1878-7479</issn><issn>1878-7479</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp9kUlPHDEQhS0EAgL8gRwiS7kQaQxe2m37EmnEOhKLNLQ4xrK7PWDU057Y3Sjh1-NhWJILp6pSvXr1pA-ArwQfEIzFYSKMEYIwxQhjRQkSa2CbSCGRKIRaz71iDAlK2Bb4ktIDxpwxJTfBFqNSYsmLbfCrctH0YW7g1M3Do2lH8KZ3MfhmBCe3k7MRnPp--OPnxkLTNbAKtW_907Cc9yt0M5lWP6Dv4LjrPbq6PB5P4UlXu8W9aX3v0y7YmJk2ub3XugOq05Pq6BxdXJ9NjsYXqC5E0aOSc-xKK6ySbmaLppSKN05QSZSxZYMV5rUgjirKaoapZcoImU-tkWRmG7YDfq5sF4Odu6Z2XR9Nqxcx545_dTBe_7_p_L2-C49aElIWXGSD768GMfweXOr1QxhilyNryilXmHBRZBVdqeoYUopu9v6BYL1EoldIdEaiX5DopfW3f7O9n7wxyAK2EqS86u5c_Pj9ie0zRs6Vrw</recordid><startdate>20210101</startdate><enddate>20210101</enddate><creator>Lee, Woo-Jin</creator><creator>Lee, Soon-Tae</creator><creator>Shin, Yong-Won</creator><creator>Lee, Han Sang</creator><creator>Shin, Hye-Rim</creator><creator>Kim, Do-Yong</creator><creator>Kim, Soyun</creator><creator>Lim, Jung-Ah</creator><creator>Moon, Jangsup</creator><creator>Park, Kyung-Il</creator><creator>Kim, Hee Seung</creator><creator>Chu, Kon</creator><creator>Lee, Sang Kun</creator><general>Springer International Publishing</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7TK</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88G</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2M</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PSYQQ</scope><scope>Q9U</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0001-5863-0302</orcidid></search><sort><creationdate>20210101</creationdate><title>Teratoma Removal, Steroid, IVIG, Rituximab and Tocilizumab (T-SIRT) in Anti-NMDAR Encephalitis</title><author>Lee, Woo-Jin ; Lee, Soon-Tae ; Shin, Yong-Won ; Lee, Han Sang ; Shin, Hye-Rim ; Kim, Do-Yong ; Kim, Soyun ; Lim, Jung-Ah ; Moon, Jangsup ; Park, Kyung-Il ; Kim, Hee Seung ; Chu, Kon ; Lee, Sang Kun</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c474t-6550e6b7b98efb4d6895de72819ab6d0905c71e2923c302b39a78c47ba81fbd3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Adverse events</topic><topic>Aged</topic><topic>Anti-N-Methyl-D-Aspartate Receptor Encephalitis - therapy</topic><topic>Antibodies, Monoclonal, Humanized - administration & dosage</topic><topic>Antibodies, Monoclonal, Humanized - therapeutic use</topic><topic>Biomedical and Life Sciences</topic><topic>Biomedicine</topic><topic>Child</topic><topic>Combined Modality Therapy</topic><topic>Drug Therapy, Combination</topic><topic>Encephalitis</topic><topic>Epilepsy</topic><topic>Female</topic><topic>Glutamate receptors</topic><topic>Humans</topic><topic>Immunoglobulins</topic><topic>Immunoglobulins, Intravenous - therapeutic use</topic><topic>Immunosuppressive agents</topic><topic>Immunotherapy</topic><topic>Intravenous administration</topic><topic>Male</topic><topic>Medical prognosis</topic><topic>Middle Aged</topic><topic>Monoclonal antibodies</topic><topic>N-Methyl-D-aspartic acid receptors</topic><topic>Neurobiology</topic><topic>Neurology</topic><topic>Neurosciences</topic><topic>Neurosurgery</topic><topic>Neutropenia</topic><topic>Original</topic><topic>Original Article</topic><topic>Ovarian Neoplasms - surgery</topic><topic>Patient Acuity</topic><topic>Patients</topic><topic>Population studies</topic><topic>Rituximab</topic><topic>Rituximab - administration & dosage</topic><topic>Rituximab - therapeutic use</topic><topic>Teratoma</topic><topic>Teratoma - surgery</topic><topic>Terminology</topic><topic>Testicular Neoplasms - surgery</topic><topic>Treatment Outcome</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lee, Woo-Jin</creatorcontrib><creatorcontrib>Lee, Soon-Tae</creatorcontrib><creatorcontrib>Shin, Yong-Won</creatorcontrib><creatorcontrib>Lee, Han Sang</creatorcontrib><creatorcontrib>Shin, Hye-Rim</creatorcontrib><creatorcontrib>Kim, Do-Yong</creatorcontrib><creatorcontrib>Kim, Soyun</creatorcontrib><creatorcontrib>Lim, Jung-Ah</creatorcontrib><creatorcontrib>Moon, Jangsup</creatorcontrib><creatorcontrib>Park, Kyung-Il</creatorcontrib><creatorcontrib>Kim, Hee Seung</creatorcontrib><creatorcontrib>Chu, Kon</creatorcontrib><creatorcontrib>Lee, Sang Kun</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Neurosciences Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Psychology Database (Alumni)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Psychology Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest One Psychology</collection><collection>ProQuest Central Basic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Neurotherapeutics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lee, Woo-Jin</au><au>Lee, Soon-Tae</au><au>Shin, Yong-Won</au><au>Lee, Han Sang</au><au>Shin, Hye-Rim</au><au>Kim, Do-Yong</au><au>Kim, Soyun</au><au>Lim, Jung-Ah</au><au>Moon, Jangsup</au><au>Park, Kyung-Il</au><au>Kim, Hee Seung</au><au>Chu, Kon</au><au>Lee, Sang Kun</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Teratoma Removal, Steroid, IVIG, Rituximab and Tocilizumab (T-SIRT) in Anti-NMDAR Encephalitis</atitle><jtitle>Neurotherapeutics</jtitle><stitle>Neurotherapeutics</stitle><addtitle>Neurotherapeutics</addtitle><date>2021-01-01</date><risdate>2021</risdate><volume>18</volume><issue>1</issue><spage>474</spage><epage>487</epage><pages>474-487</pages><issn>1933-7213</issn><issn>1878-7479</issn><eissn>1878-7479</eissn><abstract>In anti-N-methyl-
d
-aspartate receptor (NMDAR) encephalitis, we analysed the efficacy of a combined immunotherapy protocol consisting of teratoma removal, steroid, intravenous immunoglobulin (IVIG), rituximab and tocilizumab (T-SIRT). This cohort study included seventy-eight consecutive patients treated for anti-NMDAR encephalitis between Jan 2014 and Oct 2019 in a national referral hospital. Detailed 2-year disease time course was analysed using Clinical Assessment Scale for Autoimmune Encephalitis (CASE) scores at every 2 weeks for 12 weeks from baseline, every month for the next 3 months and then every 3 months. Treatment regimens at each time point were categorized as SI, SIR, or SIRT with/without teratoma removal (T). Adverse events were classified according to the Common Terminology Criteria for Adverse-Events (CTCAE v5.0), where a severe adverse event was defined as an adverse event with CATAE grade 4. In a linear mixed model analysis, using the SIRT regimen was more effective than SIR or SI regimens in lowering CASE scores (
P
< 0.001 and
P
= 0.001, respectively). The presence of teratoma (
P
= 0.001), refractory status epilepticus (
P
< 0.001) and a higher CASE score at baseline (
P
< 0.001) predicted a higher CASE score at each time point. Completion of the (T)-SIRT regimen within 1 month of onset resulted in better 1-year improvements in CASE score (
P
< 0.001) and modified Rankin scale scores (
P
= 0.001), compared to those of using other regimens within 1 month or delaying teratoma removal for more than 1 month. Pneumonia was a frequent adverse event (52/78, 66.7%) in the whole study population and neutropenia was frequent during SIRT (11/52, 21.2%), but the regimen was well tolerated in most patients. We concluded that the early application of combined immunotherapy consisting of T-SIRT had better efficacy than was found for delayed or partial application of this combination in anti-NMDAR encephalitis.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>32880854</pmid><doi>10.1007/s13311-020-00921-7</doi><tpages>14</tpages><orcidid>https://orcid.org/0000-0001-5863-0302</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1933-7213 |
| ispartof | Neurotherapeutics, 2021-01, Vol.18 (1), p.474-487 |
| issn | 1933-7213 1878-7479 1878-7479 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8116457 |
| source | MEDLINE; EZB-FREE-00999 freely available EZB journals; PubMed Central; Alma/SFX Local Collection; SpringerLink Journals - AutoHoldings |
| subjects | Adolescent Adult Adverse events Aged Anti-N-Methyl-D-Aspartate Receptor Encephalitis - therapy Antibodies, Monoclonal, Humanized - administration & dosage Antibodies, Monoclonal, Humanized - therapeutic use Biomedical and Life Sciences Biomedicine Child Combined Modality Therapy Drug Therapy, Combination Encephalitis Epilepsy Female Glutamate receptors Humans Immunoglobulins Immunoglobulins, Intravenous - therapeutic use Immunosuppressive agents Immunotherapy Intravenous administration Male Medical prognosis Middle Aged Monoclonal antibodies N-Methyl-D-aspartic acid receptors Neurobiology Neurology Neurosciences Neurosurgery Neutropenia Original Original Article Ovarian Neoplasms - surgery Patient Acuity Patients Population studies Rituximab Rituximab - administration & dosage Rituximab - therapeutic use Teratoma Teratoma - surgery Terminology Testicular Neoplasms - surgery Treatment Outcome Young Adult |
| title | Teratoma Removal, Steroid, IVIG, Rituximab and Tocilizumab (T-SIRT) in Anti-NMDAR Encephalitis |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-08T18%3A54%3A30IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Teratoma%20Removal,%20Steroid,%20IVIG,%20Rituximab%20and%20Tocilizumab%20(T-SIRT)%20in%20Anti-NMDAR%20Encephalitis&rft.jtitle=Neurotherapeutics&rft.au=Lee,%20Woo-Jin&rft.date=2021-01-01&rft.volume=18&rft.issue=1&rft.spage=474&rft.epage=487&rft.pages=474-487&rft.issn=1933-7213&rft.eissn=1878-7479&rft_id=info:doi/10.1007/s13311-020-00921-7&rft_dat=%3Cproquest_pubme%3E2525901574%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2525901574&rft_id=info:pmid/32880854&rfr_iscdi=true |