Short delay to initiate plasma exchange or immunoadsorption as synergistic therapies for patients in the acute phase of anti-NMDAR encephalitis.

IF 4.7 2区医学 Q1 CLINICAL NEUROLOGY Therapeutic Advances in Neurological Disorders Pub Date : 2024-11-13 eCollection Date: 2024-01-01 DOI:10.1177/17562864241276208

Miao Su, Zichao Wu, Qiuyan Luo, Huiyu Feng, Hongyan Zhou

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Abstract

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.

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短暂延迟启动血浆置换或免疫吸附，作为抗 NMDAR 脑炎急性期患者的协同疗法。

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。

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

Therapeutic Advances in Neurological Disorders CLINICAL NEUROLOGY-

CiteScore

8.30

自引率

1.70%

发文量

审稿时长

15 weeks

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.