Long-term efficacy and safety of different corticosteroid courses plus mycophenolate mofetil for autoimmune encephalitis with neuronal surface antibodies without tumor.
Long-term efficacy and safety of different corticosteroid courses plus mycophenolate mofetil for autoimmune encephalitis with neuronal surface antibodies without tumor.
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DOI：
10.3389/fimmu.2023.1195172
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发表时间：
2023
影响因子：
7.3
通讯作者：
中科院分区：
文献类型：
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比较不同疗程糖皮质激素联合霉酚酸酯（MMF）维持治疗无肿瘤伴神经元表面抗体（NSAbs）的自身免疫性脑炎（AE）的疗效和安全性，探讨糖皮质激素的最佳疗程。2015年6月至2020年11月连续入组55例明确AE且无肿瘤的患者，根据皮质类固醇治疗的疗程回顾性分为三组，即，病程3-6个月组（3- 6 mo组）、6-12个月组（6- 12 mo组）、>12个月组（> 12 mo组）。记录人口统计学数据、临床表现和辅助检查结果。随访激素治疗的剂量、疗程、神经功能恢复情况、不良反应的发生及复发情况。最终分析共纳入55例患者。3-6个月组、6-12个月组和>12个月组的患者数量分别为14、17和24例。在>12个月组中，发病时意识水平下降的患者比例（12，50%）显著高于3-6个月组和6-12个月组（2，14.3%; 3，17.6%）（p = 0.033）。MRI异常的发生率在6-12个月组和>12个月组（10，58.8%; 16，66.7%）显著高于3-6个月组（3，21.4%）（P=0.023）。有序回归分析显示，意识下降与皮质类固醇的疗程有关（OR=3.838，95% CI：1.103-13.323，P=0.035）。长期治疗前3个月内，3组间皮质类固醇累积剂量无显著性差异（P>0.05）。此外，在开始长期治疗后的前6个月内，未发现6-12个月组和>12个月组患者之间皮质类固醇累积剂量的显著差异。三组一线治疗前后或末次随访时mRS评分均无统计学意义。Bonferroni多重比较检验表明，6-12个月组和>12个月组患者在开始长期治疗后3个月和12个月的mRS评分无统计学意义。随访期间，50例（90.9%）患者获得了满意的神经功能（mRS评分≤2）。5例患者（9.1%）经历了首次复发，其中2例与抗NMDA受体和胶质细胞抗体重叠。不良反应发生率在>12个月组（17，70.8%）显著高于3-6个月组（3，21.4%）和6-12个月组（5，29.4%）（P=0.003）。口服皮质类固醇治疗的有益效果可能不会持续超过12个月，甚至可能导致不良反应的发生率增加。为了优化治疗的有效性和安全性，我们建议皮质类固醇疗程为3-12个月。意识水平降低的患者可能更倾向于选择较长疗程的皮质类固醇进行长期治疗。患有“重叠综合征”的患者可能需要更强烈的免疫治疗以防止复发。
To compare the efficacy and safety of different-course corticosteroids plus mycophenolate mofetil (MMF) as maintenance therapy in autoimmune encephalitis (AE) with neuronal surface antibodies (NSAbs) without tumor and explore the optimal course of corticosteroids. Fifty-five patients with definite AE without tumor were enrolled consecutively between June 2015 and November 2020 and retrospectively divided three groups according to the course of treatment with corticosteroid, i.e., a group of patients with a course of 3-6 months (Group 3-6mo), 6-12 months (Group 6-12mo), and >12 months (Group >12mo). Demographic data, clinical manifestation and ancillary tests results were recorded. The dosage and courses of corticosteroid treatment, the recovery of neurological function, the occurrence of adverse effects, and relapses were followed up. A total of 55 patients were included in the final analysis. The numbers of patients in Group 3-6 mo, Group 6-12 mo, and Group >12 mo was 14, 17, and 24, respectively. A significantly higher proportion of patients in Group >12 mo showed a decreased level of consciousness at the onset (12, 50%) than in Group 3-6 mo and Group 6-12 mo (2,14.3%; 3, 17.6%) (p = 0.033). The incidence of MRI abnormalities was significantly higher in Group 6-12 mo and Group >12 mo (10, 58.8%; 16, 66.7%) than in Group 3-6 mo (3, 21.4%) (P=0.023). Ordinal regression analysis indicated that decreased level of consciousness was associated with the course of corticosteroid (OR=3.838, 95% CI: 1.103-13.323, P=0.035). No significant difference was observed between the three groups regarding the cumulative dose of corticosteroids administered during the first three months of long-term treatment (P>0.05). Additionally, no significant difference in the cumulative dosage of corticosteroids was found between patients in Group 6-12 months and Group >12 months during the first 6 months after beginning long-term treatment. The mRS scores of the three groups were not statistically significant before and after first-line treatment or at the last follow-up. Bonferroni multiple comparison test indicated that the mRS scores of patients in Group 6-12 months and Group >12 months were not statistically significant at 3 months and 12 months after the start of long-term treatment. During the follow-up, 50 (90.9%) patients achieved satisfactory neurological function (mRS score ≤2). Five patients (9.1%) experienced a first relapse and 2 of them were overlapped with both anti-NMDA receptor and glial antibodies. The incidence of adverse effects was significantly higher in Group >12 mo (17, 70.8%) than in Group 3-6 mo (3, 21.4%) and Group 6-12 mo (5, 29.4%) (P=0.003). The beneficial effects of oral corticosteroid treatment may do not persist beyond 12 months and may even contribute to an increased incidence of adverse effects. In order to optimize the effectiveness and safety of treatment, we recommend a corticosteroid course of 3-12 months. Patients with reduced levels of consciousness may be more inclined to choose longer courses of corticosteroids for long-term treatment. Patients with an “overlapping syndrome” may require more intense immunotherapy to prevent relapse.
吗替麦考酚酯治疗小儿抗NMDAR脑炎6例疗效回顾性分析。
影响因子：
3.4
作者：
Hao XS;Wang JT;Chen C;Hao YP;Liang JM;Liu SY
通讯作者：
Liu SY