Rituximab treatment for autoimmune limbic encephalitis in an institutional cohort
- Authors
- Lee, Woo-Jin; Lee, Soon-Tae; Byun, Jung-Ick; Sunwoo, Jun-Sang; Kim, Tae-Joon; Lim, Jung-Ah; Moon, Jangsup; Lee, Han Sang; Shin, Yong-Won; Lee, Keon-Joo; Kim, Soyun; Jung, Keun-Hwa; Jung, Ki-Young; Chu, Kon; Lee, Sang Kun
- Issue Date
- 3-May-2016
- Publisher
- Lippincott Williams & Wilkins Ltd.
- Keywords
- Autoimmune limbic encephalitis; Rituximab
- Citation
- Neurology, v.86, no.18, pp 1683 - 1691
- Pages
- 9
- Journal Title
- Neurology
- Volume
- 86
- Number
- 18
- Start Page
- 1683
- End Page
- 1691
- URI
- https://scholarworks.bwise.kr/sch/handle/2021.sw.sch/9118
- DOI
- 10.1212/WNL.0000000000002635
- ISSN
- 0028-3878
1526-632X
- Abstract
- Objective: To determine efficacy and safety of rituximab treatment as a second-line immunotherapy treatment for autoimmune limbic encephalitis (ALE) and to determine factors associated with functional improvement and favorable outcome following rituximab treatment. Methods: We recruited 80 patients with ALE who were treated with rituximab as a second-line immunotherapy from the Korea Autoimmune Synaptic and Paraneoplastic Encephalitis Registry and reviewed 81 patients without rituximab as a control. We grouped patients according to the detection or type of antibodies; in addition, we evaluated clinical, laboratory, first-line immunotherapy, and rituximab treatment profiles and defined main outcomes as improvements on the modified Rankin Scale (mRS) score and a favorable mRS score (0-2) at the last follow-up. Results: Functional improvement occurred more frequently in the rituximab group compared to the control group. In the rituximab group, 30 (37.5%) patients had synaptic autoantibodies, 15 (18.8%) in the paraneoplastic autoantibodies, and 35 (43.8%) were antibody-negative. The effect of rituximab was the same regardless of autoantibody status. Additional monthly rituximab therapy and partial response to first-line immunotherapies were associated with mRS score improvements, as well as favorable mRS scores. mRS scores of 4-6 as the worst neurologic status predicted an unfavorable mRS score. There were no reported serious infusion-related or infectious adverse effects of rituximab. Conclusions: Rituximab is effective and safe as a second-line immunotherapy for ALE, regardless of autoantibody status. Additional monthly rituximab therapy might potentiate the efficacy of rituximab. Classification of evidence: This study provides Class IV evidence that rituximab improves mRS scores for patients with autoimmune limbic encephalitis who fail first-line therapy.
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Collections - College of Medicine > Department of Neurology > 1. Journal Articles
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