Differences in treatment of anti-NMDA receptor encephalitis: results of a worldwide survey
Differences in treatment of anti-NMDA receptor encephalitis: results of a worldwide survey
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DOI：
10.1007/s00415-017-8407-1
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发表时间：
2017-04-01
影响因子：
6
通讯作者：
Muscal, Eyal
中科院分区：
文献类型：
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作者：
Bartolini, Luca;Muscal, Eyal
该研究的目的是根据治疗医生的专业、地理位置和实践年限来确定抗NMDA受体脑炎的治疗策略的差异。我们通过神经病学(A(R))临床实践的当前实践部分进行了一项匿名的全球电子调查，以评估关于抗NMDA受体脑炎的一线和二线治疗以及开始二线治疗的时间的决定的差异。399名参与者回答了调查的所有问题，并被纳入分析。261名(65%)是成人神经科医生，86名(22%)是治疗儿童的神经科医生，52名(13%)是儿科风湿科医生。179名(45%)应答者在美国执业。大多数人同意一线治疗使用类固醇和/或静脉注射免疫球蛋白，二线治疗仅使用利妥昔单抗。基于专业的初始治疗方案的差异包括成人神经科医生更多地使用血浆交换(27%)，儿童风湿科医生更多地使用利妥昔单抗(29%)(chi(2)(4)=27.43p<；0.001)。受训者选择血浆置换(35%)，初级教员更多地选择美罗华(15%)作为一线治疗的一部分(chi(2)(4)=13.37p=0.010)。在美国以外的二线治疗中，抗代谢药物的使用率更高(15%)(chi(2)(4)=11.67，p=0.020)。美国医生也比大多数欧洲医生更早使用二线治疗(14%对23%的人在两周后使用；chi(2)(1)=4.96，p=0.026)。尽管治疗模式相似，但在不同专业和地理位置观察到的差异可能会指导多学科工作组制定以共识为导向的指南。这些指南可能会促进免疫调节剂治疗自身免疫性脑炎的试验。
The objective of the study was to identify differences in treatment strategies for anti-NMDA receptor encephalitis based on specialty of treating physicians, geographic location, and years in practice. We conducted an anonymous worldwide electronic survey through the Practice Current section of Neurology(A (R)) Clinical Practice to appraise differences in decisions about first- and second-line treatment and timing for initiation of second-line treatment for anti-NMDA receptor encephalitis. 399 participants answered all questions of the survey and were included in the analysis. 261 (65%) were adult neurologists, 86 (22%) were neurologists treating children, and 52 (13%) were pediatric rheumatologists. 179 (45%) responders practiced in the US. The majority agreed on the use of steroids and/or IVIg for first-line therapy and rituximab alone as second line. Differences in initial treatment regimen based on specialty included increased use of plasma exchange by adult neurologists (27%) and rituximab by pediatric rheumatologists (29%) (chi (2)(4) = 27.43, p < 0.001). Trainees opted for plasma exchange (35%) and junior faculty picked rituximab (15%) more as part of first line (chi (2)(4) = 13.37, p = 0.010). There was greater usage of anti-metabolites for second-line therapy outside of the US (15%) (chi (2)(4) = 11.67, p = 0.020). US physicians also utilized second-line treatment earlier than their mostly European counterparts (14 vs. 23% used later than 2 weeks; chi (2)(1) = 4.96, p = 0.026). Although treatment patterns were similar, differences observed across specialties and geographic locations may guide the development of consensus-driven guidelines by multi-disciplinary task forces. These guidelines may promote treatment trials of immunomodulators in autoimmune encephalitides.